1629308515 NPI number — DR. NIKI HIMAT TANK MD

Table of content: DR. NIKI HIMAT TANK MD (NPI 1629308515)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1629308515 NPI number — DR. NIKI HIMAT TANK MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TANK
Provider First Name:
NIKI
Provider Middle Name:
HIMAT
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
PATEL
Provider Other First Name:
NIKI
Provider Other Middle Name:
DIPESH
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1629308515
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/17/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
625 SOUTH FAIR OAKS AVE
Provider Second Line Business Mailing Address:
SUITE 345
Provider Business Mailing Address City Name:
PASADENA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91105
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
424-314-0203
Provider Business Mailing Address Fax Number:
424-314-0205

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
625 SOUTH FAIR OAKS AVE
Provider Second Line Business Practice Location Address:
SUITE 345
Provider Business Practice Location Address City Name:
PASADENA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91105
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
424-314-0203
Provider Business Practice Location Address Fax Number:
424-314-0205
Provider Enumeration Date:
12/28/2009

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: 207R00000X , with the licence number:  A114900 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RX0202X , with the licence number: A114900 , 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)