Provider Demographics
NPI:1750479168
Name:VACHHANI, KISHOR D (MD)
Entity Type:Individual
Prefix:DR
First Name:KISHOR
Middle Name:D
Last Name:VACHHANI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:81 833 DR CARREON BVD
Mailing Address - Street 2:SUITE 7
Mailing Address - City:INDIO
Mailing Address - State:CA
Mailing Address - Zip Code:92201-5590
Mailing Address - Country:US
Mailing Address - Phone:760-775-8889
Mailing Address - Fax:760-775-6192
Practice Address - Street 1:81 833 DR CARREON BVD
Practice Address - Street 2:SUITE 7
Practice Address - City:INDIO
Practice Address - State:CA
Practice Address - Zip Code:92201-5590
Practice Address - Country:US
Practice Address - Phone:760-775-8889
Practice Address - Fax:760-775-6192
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-11
Last Update Date:2011-06-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA49663207R00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA5120131Medicaid
CA00A496630Medicare PIN
CA5120131Medicaid