Basic Information
| Provider Information | |||||||||
| NPI: | 1992808992 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | REDDY | ||||||||
| FirstName: | THIRUPATHI | ||||||||
| MiddleName: | K | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2333 MOWRY AVE | ||||||||
| Address2: | SUITE 300 | ||||||||
| City: | FREMONT | ||||||||
| State: | CA | ||||||||
| PostalCode: | 94538 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5107960222 | ||||||||
| FaxNumber: | 5107967760 | ||||||||
| Practice Location | |||||||||
| Address1: | 175 N JACKSON AVE STE 103 | ||||||||
| Address2: | |||||||||
| City: | SAN JOSE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 951161909 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4082721600 | ||||||||
| FaxNumber: | 4087291600 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/06/2006 | ||||||||
| LastUpdateDate: | 08/24/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 01/14/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RC0000X | A54174 | CA | N | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease | 207R00000X | A54174 | CA | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 215298 | 05 | CA | MEDICAID |