Provider Demographics
NPI:1134121049
Name:KAMRA, DHEERAJ (MD)
Entity Type:Individual
Prefix:DR
First Name:DHEERAJ
Middle Name:
Last Name:KAMRA
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 1:6608 MERCY CT
Mailing Address - Street 2:SUITE C
Mailing Address - City:FAIR OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:95628-3170
Mailing Address - Country:US
Mailing Address - Phone:916-966-8500
Mailing Address - Fax:916-966-8555
Practice Address - Street 1:6608 MERCY CT STE C
Practice Address - Street 2:
Practice Address - City:FAIR OAKS
Practice Address - State:CA
Practice Address - Zip Code:95628-3171
Practice Address - Country:US
Practice Address - Phone:916-966-8500
Practice Address - Fax:916-966-8555
Is Sole Proprietor?:No
Enumeration Date:2005-08-11
Last Update Date:2018-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI43437-020207R00000X
CAA89808207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
H73621Medicare UPIN