1780683193 NPI number — DR. USHAKANT THAKKAR M.D.

Table of content: DR. USHAKANT THAKKAR M.D. (NPI 1780683193)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1780683193 NPI number — DR. USHAKANT THAKKAR M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
THAKKAR
Provider First Name:
USHAKANT
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
TUCKER
Provider Other First Name:
KANT
Provider Other Middle Name:
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.D.
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1780683193
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 940838
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SIMI VALLEY
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
93094-0838
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
805-433-7777
Provider Business Mailing Address Fax Number:
805-433-7607

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2650 JONES WAY
Provider Second Line Business Practice Location Address:
SUITE 3
Provider Business Practice Location Address City Name:
SIMI VALLEY
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93065-1203
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
805-584-0177
Provider Business Practice Location Address Fax Number:
805-584-1179
Provider Enumeration Date:
07/18/2005

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207RN0300X , with the licence number:  A35483 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 00A354830 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".