Provider Demographics
NPI:1093972382
Name:KURUPATH, VINOD (MD)
Entity Type:Individual
Prefix:
First Name:VINOD
Middle Name:
Last Name:KURUPATH
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 1:2350 W EL CAMINO REAL FL 2
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN VIEW
Mailing Address - State:CA
Mailing Address - Zip Code:94040-6203
Mailing Address - Country:US
Mailing Address - Phone:510-204-8120
Mailing Address - Fax:510-649-1238
Practice Address - Street 1:2850 TELEGRAPH AVE
Practice Address - Street 2:SUITE 120
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94705-1192
Practice Address - Country:US
Practice Address - Phone:510-204-8120
Practice Address - Fax:510-649-1238
Is Sole Proprietor?:No
Enumeration Date:2008-05-22
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA116636207RG0100X
NY237562207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA116636OtherSTATE MEDICAL LICENSE
CABK9443843OtherFEDERAL DEA LICENSE