Provider Demographics
NPI:1215146576
Name:VINOD KUMAR GARG MD INC
Entity type:Organization
Organization Name:VINOD KUMAR GARG MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:VINOD
Authorized Official - Middle Name:KUMAR
Authorized Official - Last Name:GARG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:909-868-6800
Mailing Address - Street 1:250 W BONITA AVE STE 250
Mailing Address - Street 2:
Mailing Address - City:POMONA
Mailing Address - State:CA
Mailing Address - Zip Code:91767-1864
Mailing Address - Country:US
Mailing Address - Phone:909-868-6800
Mailing Address - Fax:909-256-2488
Practice Address - Street 1:250 W BONITA AVE STE 250
Practice Address - Street 2:
Practice Address - City:POMONA
Practice Address - State:CA
Practice Address - Zip Code:91767-1864
Practice Address - Country:US
Practice Address - Phone:909-868-6800
Practice Address - Fax:909-256-2488
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-22
Last Update Date:2019-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA49049174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A490491Medicaid
CA00A490490Medicare ID - Type Unspecified
CA00A490491Medicaid