Provider Demographics
NPI:1194787275
Name:KADAKIA, NIMISH RAJ (MD)
Entity type:Individual
Prefix:DR
First Name:NIMISH
Middle Name:RAJ
Last Name:KADAKIA
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:24331 EL TORO RD STE 200
Mailing Address - Street 2:
Mailing Address - City:LAGUNA WOODS
Mailing Address - State:CA
Mailing Address - Zip Code:92637-3116
Mailing Address - Country:US
Mailing Address - Phone:949-870-3332
Mailing Address - Fax:951-264-4327
Practice Address - Street 1:22 ODYSSEY STE 205
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92618-3197
Practice Address - Country:US
Practice Address - Phone:949-870-3332
Practice Address - Fax:949-900-2116
Is Sole Proprietor?:No
Enumeration Date:2006-04-04
Last Update Date:2023-10-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA79590207X00000X, 207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAI21250Medicare UPIN
CA5231610001Medicare NSC
CAWA79590AMedicare PIN