Provider Demographics
NPI:1407245947
Name:KAMATH, POORVA (MD)
Entity Type:Individual
Prefix:
First Name:POORVA
Middle Name:
Last Name:KAMATH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MEKHALA
Other - Middle Name:
Other - Last Name:SHENOY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2400 MOORPARK AVE
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95128-2631
Mailing Address - Country:US
Mailing Address - Phone:408-975-2730
Mailing Address - Fax:
Practice Address - Street 1:315 MERCY AVE
Practice Address - Street 2:SUITE 301
Practice Address - City:MERCED
Practice Address - State:CA
Practice Address - Zip Code:95340-8363
Practice Address - Country:US
Practice Address - Phone:209-564-3513
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-01-22
Last Update Date:2015-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA133456207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine