Provider Demographics
NPI:1710981733
Name:VIR K NANDA MD INC
Entity Type:Organization
Organization Name:VIR K NANDA MD INC
Other - Org Name:VIR K NANDA MD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:VIR
Authorized Official - Middle Name:KUMAR
Authorized Official - Last Name:NANDA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:760-780-4960
Mailing Address - Street 1:12998 HESPERIA RD STE 204
Mailing Address - Street 2:
Mailing Address - City:VICTORVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:92395-8317
Mailing Address - Country:US
Mailing Address - Phone:760-780-4960
Mailing Address - Fax:760-780-4964
Practice Address - Street 1:12998 HESPERIA RD STE 204
Practice Address - Street 2:
Practice Address - City:VICTORVILLE
Practice Address - State:CA
Practice Address - Zip Code:92395-8317
Practice Address - Country:US
Practice Address - Phone:760-780-4960
Practice Address - Fax:760-780-4964
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-08
Last Update Date:2022-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA388830207R00000X, 207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
0862090001OtherMEDICARE DME PROVIDER
5628485OtherOTHER ID NUMBER
CA00A388830Medicaid
CA00A388830Medicaid