Provider Demographics
NPI:1710932751
Name:PATEL, BAKUL KUMAR
Entity Type:Individual
Prefix:DR
First Name:BAKUL
Middle Name:KUMAR
Last Name:PATEL
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 1:11 TECHNOLOGY DR
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92618-2302
Mailing Address - Country:US
Mailing Address - Phone:949-923-3250
Mailing Address - Fax:855-812-5865
Practice Address - Street 1:26740 TOWNE CENTRE DR
Practice Address - Street 2:
Practice Address - City:FOOTHILL RANCH
Practice Address - State:CA
Practice Address - Zip Code:92610
Practice Address - Country:US
Practice Address - Phone:949-588-9293
Practice Address - Fax:949-588-0409
Is Sole Proprietor?:No
Enumeration Date:2006-05-24
Last Update Date:2017-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA045267207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ65363ZOtherBLS
CAPENDINGOtherMEDICARE
CAZZZ65363ZOtherBLS
E42453Medicare UPIN