Provider Demographics
NPI:1992803167
Name:BIDICHANDANI-KAURA, MAYA B (MD)
Entity type:Individual
Prefix:DR
First Name:MAYA
Middle Name:B
Last Name:BIDICHANDANI-KAURA
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 1:24865 DEL PRADO
Mailing Address - Street 2:
Mailing Address - City:DANA POINT
Mailing Address - State:CA
Mailing Address - Zip Code:92629
Mailing Address - Country:US
Mailing Address - Phone:949-248-5884
Mailing Address - Fax:949-248-5886
Practice Address - Street 1:24865 DEL PRADO
Practice Address - Street 2:
Practice Address - City:DANA POINT
Practice Address - State:CA
Practice Address - Zip Code:92629
Practice Address - Country:US
Practice Address - Phone:949-248-5884
Practice Address - Fax:949-248-5886
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2011-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC41651207R00000X, 207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ47948ZOtherBLUE SHIELD
CAW13226JOtherMEDICARE GROUP NUMBER
CAC41651OtherLICENSE
CAWC41651MMedicare PIN
A61149Medicare UPIN
CAWA44509CMedicare PIN
CAA61149Medicare UPIN