Provider Demographics
NPI:1720087877
Name:JOSHI, SUDHIR SHYAM (MD)
Entity type:Individual
Prefix:DR
First Name:SUDHIR
Middle Name:SHYAM
Last Name:JOSHI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 81447
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93380-1447
Mailing Address - Country:US
Mailing Address - Phone:661-588-9999
Mailing Address - Fax:661-588-9041
Practice Address - Street 1:3933 COFFEE RD
Practice Address - Street 2:SUITE A
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93308-5024
Practice Address - Country:US
Practice Address - Phone:661-588-9999
Practice Address - Fax:661-588-9041
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-20
Last Update Date:2011-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA67076208M00000X, 207R00000X, 207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A670760Medicare ID - Type Unspecified
CAH51478Medicare UPIN
CAAR380ZMedicare PIN