Provider Demographics
NPI:1043522337
Name:KURIACHAN, VIPIN PRABHU (MD)
Entity Type:Individual
Prefix:DR
First Name:VIPIN
Middle Name:PRABHU
Last Name:KURIACHAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:2021 N MACARTHUR BLVD
Mailing Address - Street 2:STE 150
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75061-2219
Mailing Address - Country:US
Mailing Address - Phone:972-253-2560
Mailing Address - Fax:972-253-4218
Practice Address - Street 1:6750 N MACARTHUR BLVD
Practice Address - Street 2:STE 205
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75039-2875
Practice Address - Country:US
Practice Address - Phone:972-823-6430
Practice Address - Fax:972-823-6431
Is Sole Proprietor?:No
Enumeration Date:2010-07-02
Last Update Date:2017-03-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
390200000X
TXQ0489207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX3374704 01Medicaid
TX358492YSFZMedicare PIN