Provider Demographics
NPI:1962578120
Name:GARG, VINOD KUMAR (MD)
Entity type:Individual
Prefix:
First Name:VINOD
Middle Name:KUMAR
Last Name:GARG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:250 W BONITA AVE STE 250
Mailing Address - Street 2:
Mailing Address - City:POMONA
Mailing Address - State:CA
Mailing Address - Zip Code:91767-1864
Mailing Address - Country:US
Mailing Address - Phone:909-868-6800
Mailing Address - Fax:909-256-2488
Practice Address - Street 1:250 W BONITA AVE STE 250
Practice Address - Street 2:
Practice Address - City:POMONA
Practice Address - State:CA
Practice Address - Zip Code:91767-1864
Practice Address - Country:US
Practice Address - Phone:909-868-6800
Practice Address - Fax:909-256-2488
Is Sole Proprietor?:No
Enumeration Date:2006-11-28
Last Update Date:2019-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA490492086S0129X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A490491Medicaid
00A490490Medicare ID - Type Unspecified
A64157Medicare UPIN