Provider Demographics
NPI:1245243716
Name:THAKUR, DINESHKUMAR (MD)
Entity Type:Individual
Prefix:DR
First Name:DINESHKUMAR
Middle Name:
Last Name:THAKUR
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 1:1450 TREAT BLVD
Mailing Address - Street 2:STE 300
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94597-2168
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1460 N. CAMINO ALTO
Practice Address - Street 2:STE 201
Practice Address - City:VALLEJO
Practice Address - State:CA
Practice Address - Zip Code:94591-2567
Practice Address - Country:US
Practice Address - Phone:707-557-6002
Practice Address - Fax:707-557-6033
Is Sole Proprietor?:No
Enumeration Date:2006-08-14
Last Update Date:2016-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC50275207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00C502750Medicaid
CA00C502750Medicaid