Provider Demographics
NPI:1609825579
Name:MARFATIA, VIKRAM (MD)
Entity Type:Individual
Prefix:DR
First Name:VIKRAM
Middle Name:
Last Name:MARFATIA
Suffix:
Gender:M
Credentials:MD
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 6768
Mailing Address - Street 2:
Mailing Address - City:BUENA PARK
Mailing Address - State:CA
Mailing Address - Zip Code:90622-6768
Mailing Address - Country:US
Mailing Address - Phone:562-814-5602
Mailing Address - Fax:562-817-5605
Practice Address - Street 1:3300 E SOUTH ST
Practice Address - Street 2:SUITE # 305
Practice Address - City:LAKEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90805-4549
Practice Address - Country:US
Practice Address - Phone:562-817-5602
Practice Address - Fax:562-817-5605
Is Sole Proprietor?:No
Enumeration Date:2006-05-09
Last Update Date:2019-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA63658208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A636580Medicaid
CAG43473Medicare UPIN
CA00A636580Medicaid