Provider Demographics
NPI:1477832277
Name:TANJA L. KUJAC, MD INC
Entity Type:Organization
Organization Name:TANJA L. KUJAC, MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:TANYA
Authorized Official - Middle Name:LYNNE
Authorized Official - Last Name:KUJAC
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:925-256-6583
Mailing Address - Street 1:PO BOX #183
Mailing Address - Street 2:3000 F DANVILLE BLVD
Mailing Address - City:ALAMO
Mailing Address - State:CA
Mailing Address - Zip Code:94507
Mailing Address - Country:US
Mailing Address - Phone:925-256-6583
Mailing Address - Fax:925-256-6583
Practice Address - Street 1:710 SOUTH BROADWAY
Practice Address - Street 2:STE 110
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94596
Practice Address - Country:US
Practice Address - Phone:925-256-6583
Practice Address - Fax:925-256-6583
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-10
Last Update Date:2011-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA0634512081H0002X, 2081N0008X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2081H0002XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationHospice and Palliative MedicineGroup - Multi-Specialty
No2081N0008XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationNeuromuscular MedicineGroup - Multi-Specialty