Provider Demographics
NPI:1699840728
Name:BUTTAN, VINAY K (MD)
Entity Type:Individual
Prefix:
First Name:VINAY
Middle Name:K
Last Name:BUTTAN
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 1:166 N VILLA ST
Mailing Address - Street 2:
Mailing Address - City:PORTERVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:93257
Mailing Address - Country:US
Mailing Address - Phone:559-782-1990
Mailing Address - Fax:559-782-1163
Practice Address - Street 1:166 N VILLA ST
Practice Address - Street 2:
Practice Address - City:PORTERVILLE
Practice Address - State:CA
Practice Address - Zip Code:93257
Practice Address - Country:US
Practice Address - Phone:559-782-1990
Practice Address - Fax:559-782-1163
Is Sole Proprietor?:No
Enumeration Date:2006-11-22
Last Update Date:2012-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA33656207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A336561Medicaid
00A336561Medicare ID - Type Unspecified
A27214Medicare UPIN