Provider Demographics
NPI:1619906872
Name:KUNDARIA, BHANJI D (MD)
Entity Type:Individual
Prefix:
First Name:BHANJI
Middle Name:D
Last Name:KUNDARIA
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 1:1505 SHEPARD DR STE 106
Mailing Address - Street 2:
Mailing Address - City:SANTA MARIA
Mailing Address - State:CA
Mailing Address - Zip Code:93454-7016
Mailing Address - Country:US
Mailing Address - Phone:805-922-6616
Mailing Address - Fax:805-928-7243
Practice Address - Street 1:1505 SHEPARD DR STE 106
Practice Address - Street 2:
Practice Address - City:SANTA MARIA
Practice Address - State:CA
Practice Address - Zip Code:93454-7016
Practice Address - Country:US
Practice Address - Phone:805-922-6616
Practice Address - Fax:805-928-7243
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-01
Last Update Date:2008-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA35703174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A357030Medicaid
CAWA35703BMedicare PIN
CAA88349Medicare UPIN