Provider Demographics
NPI:1588659247
Name:KAUL, SANJIV M (DO)
Entity Type:Individual
Prefix:
First Name:SANJIV
Middle Name:M
Last Name:KAUL
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 6098
Mailing Address - Street 2:
Mailing Address - City:VISALIA
Mailing Address - State:CA
Mailing Address - Zip Code:93290-6098
Mailing Address - Country:US
Mailing Address - Phone:559-802-3635
Mailing Address - Fax:
Practice Address - Street 1:840 S AKERS ST
Practice Address - Street 2:
Practice Address - City:VISALIA
Practice Address - State:CA
Practice Address - Zip Code:93277-8309
Practice Address - Country:US
Practice Address - Phone:559-624-3710
Practice Address - Fax:559-635-4001
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-19
Last Update Date:2011-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A113572081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK7141450OtherAETNA
OKP00031487OtherRAILROAD MEDICARE
OK200012700AMedicaid
OK487023200OtherDOL
OK7141450OtherAETNA
OK200012700AMedicaid