Provider Demographics
NPI:1700393030
Name:KAUL, VIKRAM
Entity Type:Individual
Prefix:
First Name:VIKRAM
Middle Name:
Last Name:KAUL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1420 WALNUT ST STE 406
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19102-4003
Mailing Address - Country:US
Mailing Address - Phone:267-519-9885
Mailing Address - Fax:
Practice Address - Street 1:1420 WALNUT ST STE 406
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19102-4003
Practice Address - Country:US
Practice Address - Phone:267-519-9885
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-09
Last Update Date:2018-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA34553601374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA34553601OtherPA DEPARTMENT OF HEALTH - HOME CARE LICENSE