Provider Demographics
NPI:1386841963
Name:NANDA, VIR KUMAR (MD)
Entity Type:Individual
Prefix:
First Name:VIR
Middle Name:KUMAR
Last Name:NANDA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:12998 HESPERIA RD
Mailing Address - Street 2:SUITE 204
Mailing Address - City:VICTORVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:92395-8316
Mailing Address - Country:US
Mailing Address - Phone:760-780-4960
Mailing Address - Fax:760-780-4964
Practice Address - Street 1:12998 HESPERIA RD
Practice Address - Street 2:SUITE 204
Practice Address - City:VICTORVILLE
Practice Address - State:CA
Practice Address - Zip Code:92395-8316
Practice Address - Country:US
Practice Address - Phone:760-780-4960
Practice Address - Fax:760-780-4964
Is Sole Proprietor?:No
Enumeration Date:2007-06-28
Last Update Date:2009-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA38883207R00000X, 207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA110232685OtherRAILROAD MEDICARE
CA33-0324608OtherTRI CARE
CA00A388830Medicaid
CAA28751Medicare UPIN
CA00A388830Medicare ID - Type Unspecified