Provider Demographics
NPI:1508907023
Name:KARTIK THAKER M.D. INC.
Entity Type:Organization
Organization Name:KARTIK THAKER M.D. INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KARTIK
Authorized Official - Middle Name:
Authorized Official - Last Name:THAKER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:562-630-2360
Mailing Address - Street 1:PO BOX 3006
Mailing Address - Street 2:
Mailing Address - City:CERRITOS
Mailing Address - State:CA
Mailing Address - Zip Code:90703-3006
Mailing Address - Country:US
Mailing Address - Phone:562-630-2360
Mailing Address - Fax:562-633-0510
Practice Address - Street 1:3650 SOUTH ST
Practice Address - Street 2:SUITE 210
Practice Address - City:LAKEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90712-1502
Practice Address - Country:US
Practice Address - Phone:562-630-2360
Practice Address - Fax:562-633-0510
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-09
Last Update Date:2009-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA45557207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A455570Medicaid
CAW18672Medicare ID - Type Unspecified
CAF22313Medicare UPIN