Provider Demographics
NPI:1689863482
Name:NIMISH R KADAKIA, MD, INC.
Entity Type:Organization
Organization Name:NIMISH R KADAKIA, MD, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NIMISH
Authorized Official - Middle Name:RAJ
Authorized Official - Last Name:KADAKIA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:949-727-3636
Mailing Address - Street 1:16300 SAND CANYON AVENUE
Mailing Address - Street 2:SUITE 511
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92618-3705
Mailing Address - Country:US
Mailing Address - Phone:949-727-3636
Mailing Address - Fax:949-727-9515
Practice Address - Street 1:16300 SAND CANYON AVENUE
Practice Address - Street 2:SUITE 511
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92618-3705
Practice Address - Country:US
Practice Address - Phone:949-727-3636
Practice Address - Fax:949-727-9515
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-17
Last Update Date:2007-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA79590174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
W18117Medicare UPIN