Provider Demographics
NPI:1114063575
Name:TEJURA, KANEYALAL BHAGWANJI (MD)
Entity Type:Individual
Prefix:DR
First Name:KANEYALAL
Middle Name:BHAGWANJI
Last Name:TEJURA
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 1:760 WASHBURN AVE
Mailing Address - Street 2:SUITE # 20
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92882-3303
Mailing Address - Country:US
Mailing Address - Phone:951-734-1955
Mailing Address - Fax:951-734-9154
Practice Address - Street 1:760 WASHBURN AVE
Practice Address - Street 2:SUITE # 20
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92882-3303
Practice Address - Country:US
Practice Address - Phone:951-734-1955
Practice Address - Fax:951-734-9154
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA30962208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A309620OtherMEDICAL