Provider Demographics
NPI:1760652184
Name:SUNKAVALLY, RAO (MD)
Entity type:Individual
Prefix:
First Name:RAO
Middle Name:
Last Name:SUNKAVALLY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1999 MOWRY AVE
Mailing Address - Street 2:SUITE 2-D
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94538-1738
Mailing Address - Country:US
Mailing Address - Phone:510-790-9025
Mailing Address - Fax:510-790-9080
Practice Address - Street 1:1999 MOWRY AVE
Practice Address - Street 2:SUITE 2-D
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94538-1738
Practice Address - Country:US
Practice Address - Phone:510-790-9025
Practice Address - Fax:510-790-9080
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-03
Last Update Date:2008-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA39536208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A395360Medicaid
CA00A395360Medicare PIN
CA00A395360Medicaid