Provider Demographics
NPI:1508832007
Name:VIJAY V KAMDAR, MD, INC
Entity Type:Organization
Organization Name:VIJAY V KAMDAR, MD, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:VIJAY
Authorized Official - Middle Name:V
Authorized Official - Last Name:KAMDAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-632-3737
Mailing Address - Street 1:PO BOX 3279
Mailing Address - Street 2:
Mailing Address - City:PALOS VERDES PENNINSULA
Mailing Address - State:CA
Mailing Address - Zip Code:90274-9279
Mailing Address - Country:US
Mailing Address - Phone:562-861-5533
Mailing Address - Fax:562-861-5535
Practice Address - Street 1:11411 BROOKSHIRE AVE STE 501
Practice Address - Street 2:
Practice Address - City:DOWNEY
Practice Address - State:CA
Practice Address - Zip Code:90241-5007
Practice Address - Country:US
Practice Address - Phone:562-861-5533
Practice Address - Fax:562-861-5535
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-24
Last Update Date:2016-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA39486207R00000X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAOOA394861Medicaid
CAOOA394861Medicaid
CAA39486Medicare PIN