Provider Demographics
NPI:1396078788
Name:BAKHRU, VIKRAM DEEPAK (MD, MBA)
Entity type:Individual
Prefix:DR
First Name:VIKRAM
Middle Name:DEEPAK
Last Name:BAKHRU
Suffix:
Gender:M
Credentials:MD, MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:8605 SANTA MONICA BLVD # 68379
Mailing Address - Street 2:
Mailing Address - City:WEST HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90069-4109
Mailing Address - Country:US
Mailing Address - Phone:888-811-9064
Mailing Address - Fax:888-553-4757
Practice Address - Street 1:505 PARNASSUS AVE
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94143-2204
Practice Address - Country:US
Practice Address - Phone:888-811-9064
Practice Address - Fax:888-553-4757
Is Sole Proprietor?:No
Enumeration Date:2009-09-16
Last Update Date:2022-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101258987208600000X
PAMD432458208600000X
AZ51121208600000X
DCMD043654208600000X
FLME124345208600000X
GA75137208600000X
IL036.138929208600000X
MA264416208600000X
MDD0079723208600000X
MI4301108575208600000X
NY279991-1208600000X
NC2015-01946208600000X
OH127192208600000X
CAC134435208D00000X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice