Provider Demographics
NPI:1538384870
Name:CHERUKURI, SIVA S (DDS)
Entity type:Individual
Prefix:
First Name:SIVA
Middle Name:S
Last Name:CHERUKURI
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23 OAKDALE ST
Mailing Address - Street 2:
Mailing Address - City:REDWOOD CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94062-1734
Mailing Address - Country:US
Mailing Address - Phone:650-839-0084
Mailing Address - Fax:650-839-0084
Practice Address - Street 1:193 ARCH ST
Practice Address - Street 2:STE B-C
Practice Address - City:REDWOOD CITY
Practice Address - State:CA
Practice Address - Zip Code:94062-1343
Practice Address - Country:US
Practice Address - Phone:650-369-4616
Practice Address - Fax:650-369-4622
Is Sole Proprietor?:No
Enumeration Date:2007-04-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA48245122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist