Provider Demographics
NPI:1316121932
Name:NANDAN V KAMATH MD A PROFESSIONAL CORPORATION
Entity type:Organization
Organization Name:NANDAN V KAMATH MD A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:NANDAN
Authorized Official - Middle Name:VASUDEV
Authorized Official - Last Name:KAMATH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:707-446-6969
Mailing Address - Street 1:941 MERCHANT ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:VACAVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95688-5315
Mailing Address - Country:US
Mailing Address - Phone:707-446-6969
Mailing Address - Fax:707-446-2775
Practice Address - Street 1:941 MERCHANT ST
Practice Address - Street 2:SUITE A
Practice Address - City:VACAVILLE
Practice Address - State:CA
Practice Address - Zip Code:95688-5315
Practice Address - Country:US
Practice Address - Phone:707-446-6969
Practice Address - Fax:707-446-2775
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-18
Last Update Date:2008-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA87880207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
I14261Medicare UPIN
CA00A878800Medicare PIN