Provider Demographics
NPI:1649400839
Name:KAMBHAMPATI, GANESH (MD)
Entity type:Individual
Prefix:
First Name:GANESH
Middle Name:
Last Name:KAMBHAMPATI
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 1:1111 EXPOSITION BLVD STE 300
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95815-4324
Mailing Address - Country:US
Mailing Address - Phone:916-929-8564
Mailing Address - Fax:916-929-4529
Practice Address - Street 1:520 COTTONWOOD ST STE 2
Practice Address - Street 2:
Practice Address - City:WOODLAND
Practice Address - State:CA
Practice Address - Zip Code:95695-3603
Practice Address - Country:US
Practice Address - Phone:530-668-3600
Practice Address - Fax:530-668-3601
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-22
Last Update Date:2025-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA117811207RN0300X, 174400000X
FLME104829207R00000X
FLTRN13965207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty
No174400000XOther Service ProvidersSpecialist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL007205500Medicaid
FLGU552ZMedicare PIN