Provider Demographics
NPI:1760665384
Name:VIJAY K WALI M D INC
Entity Type:Organization
Organization Name:VIJAY K WALI M D INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:VIJAY
Authorized Official - Middle Name:K
Authorized Official - Last Name:WALI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:714-451-0000
Mailing Address - Street 1:1001 E CHAPMAN AVE
Mailing Address - Street 2:SUITE D
Mailing Address - City:FULLERTON
Mailing Address - State:CA
Mailing Address - Zip Code:92831-3811
Mailing Address - Country:US
Mailing Address - Phone:714-451-0000
Mailing Address - Fax:
Practice Address - Street 1:1001 E CHAPMAN AVE
Practice Address - Street 2:SUITE D
Practice Address - City:FULLERTON
Practice Address - State:CA
Practice Address - Zip Code:92831-3811
Practice Address - Country:US
Practice Address - Phone:714-451-0000
Practice Address - Fax:714-451-0500
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-06
Last Update Date:2011-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADG346AOtherMEDICARE GROUP ID
CADG346AOtherMEDICARE GROUP ID