Provider Demographics
NPI:1376655068
Name:MADAN, NITI
Entity Type:Individual
Prefix:
First Name:NITI
Middle Name:
Last Name:MADAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:NITI
Other - Middle Name:
Other - Last Name:BHASIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4150 V ST
Mailing Address - Street 2:SUITE 3500
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95817-1460
Mailing Address - Country:US
Mailing Address - Phone:916-734-3774
Mailing Address - Fax:916-734-7920
Practice Address - Street 1:4150 V ST
Practice Address - Street 2:SUITE 3500
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95817-1460
Practice Address - Country:US
Practice Address - Phone:916-734-3774
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2016-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA93948207RN0300X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64085434Medicaid
I17408Medicare UPIN
0508623Medicare ID - Type Unspecified
181859Medicare ID - Type Unspecified