Provider Demographics
NPI:1437379765
Name:DECCAN PACIFIC MEDICAL GROUP
Entity Type:Organization
Organization Name:DECCAN PACIFIC MEDICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RAMESH
Authorized Official - Middle Name:C
Authorized Official - Last Name:KARIPINENI
Authorized Official - Suffix:
Authorized Official - Credentials:M D
Authorized Official - Phone:510-284-4100
Mailing Address - Street 1:1860 MOWRY AVE STE 400
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94538-1730
Mailing Address - Country:US
Mailing Address - Phone:510-284-4100
Mailing Address - Fax:510-794-9783
Practice Address - Street 1:1860 MOWRY AVE STE 400
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94538-1730
Practice Address - Country:US
Practice Address - Phone:510-284-4100
Practice Address - Fax:510-794-9783
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-27
Last Update Date:2014-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA33814174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ21948ZOtherMEDICARE ID TYPE