Provider Demographics
NPI:1104888155
Name:UPADHYAY, AJAY KUMAR (MD)
Entity type:Individual
Prefix:
First Name:AJAY
Middle Name:KUMAR
Last Name:UPADHYAY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:365 HAWTHORNE AVE
Mailing Address - Street 2:STE 101
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94609-3115
Mailing Address - Country:US
Mailing Address - Phone:510-465-5523
Mailing Address - Fax:510-832-6061
Practice Address - Street 1:365 HAWTHORNE AVE
Practice Address - Street 2:STE 101
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94609-3115
Practice Address - Country:US
Practice Address - Phone:510-465-5523
Practice Address - Fax:510-832-6061
Is Sole Proprietor?:No
Enumeration Date:2006-04-05
Last Update Date:2025-02-11
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAA53488208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0098240Medicaid
CAG31871Medicare UPIN