Provider Demographics
NPI:1811907389
Name:KAMDAR, URMILA (MD)
Entity type:Individual
Prefix:
First Name:URMILA
Middle Name:
Last Name:KAMDAR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 N TUSTIN AVE
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92705-3807
Mailing Address - Country:US
Mailing Address - Phone:714-347-1010
Mailing Address - Fax:714-647-1245
Practice Address - Street 1:4487 STONERIDGE DR
Practice Address - Street 2:
Practice Address - City:PLEASANTON
Practice Address - State:CA
Practice Address - Zip Code:94588-8326
Practice Address - Country:US
Practice Address - Phone:925-600-1900
Practice Address - Fax:714-647-1245
Is Sole Proprietor?:No
Enumeration Date:2006-08-08
Last Update Date:2012-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC52706207L00000X
IL036056553207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036056553Medicaid
CAEN805YMedicare PIN
ILK34208Medicare PIN
CAP01077654Medicare PIN
C43183Medicare UPIN
ILK26818Medicare PIN
CAEN805ZMedicare PIN