Individual
DR. VIDHATH REDDY MOKU
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
114 GATEWAY CORPORATE BLVD, COLUMBIA, SC 29203-9740
(803) 365-8640
Mailing address
114 GATEWAY CORPORATE BLVD, COLUMBIA, SC 29203-9740
(803) 365-8640
Taxonomy
Speciality
Code
Description
License number
State
2081P2900X
Pain Medicine (Physical Medicine & Rehabilitation) Physician
Primary
94650
SC
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
597729956
DRIVERS LICENSE
NY
Enumeration date
03/31/2020
Last updated
02/04/2026
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