Provider Demographics
NPI:1366538993
Name:VAIJAYANTI S KOLDHEKAR MD INC
Entity type:Organization
Organization Name:VAIJAYANTI S KOLDHEKAR MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:VAIJAYANTI
Authorized Official - Middle Name:S
Authorized Official - Last Name:KOLDHEKAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:626-303-2541
Mailing Address - Street 1:931 BUENA VISTA # 302
Mailing Address - Street 2:
Mailing Address - City:DUARTE
Mailing Address - State:CA
Mailing Address - Zip Code:91010
Mailing Address - Country:US
Mailing Address - Phone:626-303-2541
Mailing Address - Fax:626-358-5572
Practice Address - Street 1:931 BUENA VISTA # 302
Practice Address - Street 2:
Practice Address - City:DUARTE
Practice Address - State:CA
Practice Address - Zip Code:91010
Practice Address - Country:US
Practice Address - Phone:626-303-2541
Practice Address - Fax:626-358-5572
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA43547208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty