Provider Demographics
NPI:1417121682
Name:THAMPI K JOHN MD INC
Entity Type:Organization
Organization Name:THAMPI K JOHN MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:THAMPI
Authorized Official - Middle Name:K
Authorized Official - Last Name:JOHN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:559-434-6232
Mailing Address - Street 1:30 E RIVER PARK PL W
Mailing Address - Street 2:330
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93720-1545
Mailing Address - Country:US
Mailing Address - Phone:559-434-6232
Mailing Address - Fax:559-256-2452
Practice Address - Street 1:30 E RIVER PARK PL W
Practice Address - Street 2:330
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93720-1545
Practice Address - Country:US
Practice Address - Phone:559-434-6232
Practice Address - Fax:559-256-2452
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-17
Last Update Date:2008-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA52031207RC0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac ElectrophysiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG22124Medicare UPIN