Provider Demographics
NPI:1154515963
Name:VATS, DIVYA (MD)
Entity type:Individual
Prefix:
First Name:DIVYA
Middle Name:
Last Name:VATS
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 1:4650 W SUNSET BLVD
Mailing Address - Street 2:MAIL STOP # 90
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90027-6062
Mailing Address - Country:US
Mailing Address - Phone:323-361-2178
Mailing Address - Fax:323-361-1172
Practice Address - Street 1:4650 W SUNSET BLVD
Practice Address - Street 2:MAIL STOP # 90
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90027-6062
Practice Address - Country:US
Practice Address - Phone:323-361-2178
Practice Address - Fax:323-361-1172
Is Sole Proprietor?:No
Enumeration Date:2007-09-05
Last Update Date:2021-12-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IAR8236390200000X
CAA107303207SG0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207SG0202XAllopathic & Osteopathic PhysiciansMedical GeneticsClinical Biochemical Genetics
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program