Provider Demographics
NPI:1144207739
Name:THAKER, KARTIK (MD)
Entity Type:Individual
Prefix:
First Name:KARTIK
Middle Name:
Last Name:THAKER
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:PO BOX 3006
Mailing Address - Street 2:
Mailing Address - City:CERRITOS
Mailing Address - State:CA
Mailing Address - Zip Code:90703-3006
Mailing Address - Country:US
Mailing Address - Phone:562-698-7599
Mailing Address - Fax:562-696-4266
Practice Address - Street 1:3650 E SOUTH ST
Practice Address - Street 2:SUITE # 210
Practice Address - City:LAKEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90712-1502
Practice Address - Country:US
Practice Address - Phone:562-630-2360
Practice Address - Fax:562-633-0510
Is Sole Proprietor?:No
Enumeration Date:2005-12-27
Last Update Date:2022-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA45557207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
F22313Medicare UPIN