Provider Demographics
NPI:1407809304
Name:KUDRIMOTI, HEMANT S (MD PHD)
Entity type:Individual
Prefix:DR
First Name:HEMANT
Middle Name:S
Last Name:KUDRIMOTI
Suffix:
Gender:M
Credentials:MD PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3400 DATA DR
Mailing Address - Street 2:
Mailing Address - City:RANCHO CORDOVA
Mailing Address - State:CA
Mailing Address - Zip Code:95670-7956
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1561 CREEKSIDE DR STE 170
Practice Address - Street 2:
Practice Address - City:FOLSOM
Practice Address - State:CA
Practice Address - Zip Code:95630-3495
Practice Address - Country:US
Practice Address - Phone:916-351-4825
Practice Address - Fax:916-984-2055
Is Sole Proprietor?:No
Enumeration Date:2006-05-19
Last Update Date:2025-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ327632084N0400X
CA327632084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ866650Medicaid
CA32763OtherMEDICAL STATE LICENSE
81720Medicare ID - Type Unspecified