Provider Demographics
NPI:1487075735
Name:KASUKURTHI, PALLAVI
Entity type:Individual
Prefix:
First Name:PALLAVI
Middle Name:
Last Name:KASUKURTHI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8719 ELMONT AVE
Mailing Address - Street 2:
Mailing Address - City:DOWNEY
Mailing Address - State:CA
Mailing Address - Zip Code:90240-2222
Mailing Address - Country:US
Mailing Address - Phone:650-787-3788
Mailing Address - Fax:
Practice Address - Street 1:11525 BROOKSHIRE AVE
Practice Address - Street 2:SUITE 400
Practice Address - City:DOWNEY
Practice Address - State:CA
Practice Address - Zip Code:90241-4985
Practice Address - Country:US
Practice Address - Phone:562-869-1070
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-03
Last Update Date:2016-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA129742207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine