Provider Demographics
NPI:1174690473
Name:REDDY, VIJAYA D (MD)
Entity type:Individual
Prefix:DR
First Name:VIJAYA
Middle Name:D
Last Name:REDDY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:V.J.
Other - Middle Name:
Other - Last Name:REDDY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:1319 PUNAHOU ST
Mailing Address - Street 2:SUITE 1160
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96826-1001
Mailing Address - Country:US
Mailing Address - Phone:808-942-7707
Mailing Address - Fax:808-955-3301
Practice Address - Street 1:1329 LUSITANA ST
Practice Address - Street 2:SUITE 701
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96813-2429
Practice Address - Country:US
Practice Address - Phone:808-545-5515
Practice Address - Fax:808-523-5605
Is Sole Proprietor?:No
Enumeration Date:2006-11-29
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI20162080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI034484-01Medicaid
HI034484-02Medicaid
HID43614Medicare UPIN