Provider Demographics
NPI:1285766220
Name:ZEIDLER, KAMAKSHI RAIMONDO (MD)
Entity type:Individual
Prefix:
First Name:KAMAKSHI
Middle Name:RAIMONDO
Last Name:ZEIDLER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KAMAKSHI
Other - Middle Name:LEE
Other - Last Name:RAIMONDO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:3803 S BASCOM AVE
Mailing Address - Street 2:STE 100
Mailing Address - City:CAMPBELL
Mailing Address - State:CA
Mailing Address - Zip Code:95008-7317
Mailing Address - Country:US
Mailing Address - Phone:408-559-7177
Mailing Address - Fax:650-631-2448
Practice Address - Street 1:3803 S BASCOM AVE
Practice Address - Street 2:STE 100
Practice Address - City:CAMPBELL
Practice Address - State:CA
Practice Address - Zip Code:95008-7317
Practice Address - Country:US
Practice Address - Phone:408-559-7177
Practice Address - Fax:650-631-2448
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-12
Last Update Date:2016-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA95269208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADM492XMedicare PIN