Provider Demographics
NPI:1134757396
Name:REDDY, PRAJEET (MD)
Entity type:Individual
Prefix:DR
First Name:PRAJEET
Middle Name:
Last Name:REDDY
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12100 WILSHIRE BLVD STE 800
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90025-7140
Mailing Address - Country:US
Mailing Address - Phone:424-285-5349
Mailing Address - Fax:
Practice Address - Street 1:12100 WILSHIRE BLVD STE 800
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90025-7140
Practice Address - Country:US
Practice Address - Phone:424-285-5349
Practice Address - Fax:424-285-5349
Is Sole Proprietor?:No
Enumeration Date:2020-03-31
Last Update Date:2025-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA11528900207R00000X
CAA183889207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine