Provider Demographics
NPI:1609982248
Name:NAIK, MUKESH HASMUKHRAI (DO)
Entity Type:Individual
Prefix:
First Name:MUKESH
Middle Name:HASMUKHRAI
Last Name:NAIK
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 1:1001 NUT TREE RD
Mailing Address - Street 2:SUITE 140
Mailing Address - City:VACAVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95687
Mailing Address - Country:US
Mailing Address - Phone:707-301-1657
Mailing Address - Fax:
Practice Address - Street 1:1001 NUT TREE RD
Practice Address - Street 2:SUITE 140
Practice Address - City:VACAVILLE
Practice Address - State:CA
Practice Address - Zip Code:95687-4166
Practice Address - Country:US
Practice Address - Phone:707-448-9350
Practice Address - Fax:707-448-3572
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-23
Last Update Date:2017-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A6091207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAAZ650ZMedicare PIN