Provider Demographics
NPI:1780683193
Name:THAKKAR, USHAKANT (MD)
Entity Type:Individual
Prefix:DR
First Name:USHAKANT
Middle Name:
Last Name:THAKKAR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:KANT
Other - Middle Name:
Other - Last Name:TUCKER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 940838
Mailing Address - Street 2:
Mailing Address - City:SIMI VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:93094-0838
Mailing Address - Country:US
Mailing Address - Phone:805-433-7777
Mailing Address - Fax:805-433-7607
Practice Address - Street 1:2650 JONES WAY
Practice Address - Street 2:SUITE 3
Practice Address - City:SIMI VALLEY
Practice Address - State:CA
Practice Address - Zip Code:93065-1203
Practice Address - Country:US
Practice Address - Phone:805-584-0177
Practice Address - Fax:805-584-1179
Is Sole Proprietor?:No
Enumeration Date:2005-07-18
Last Update Date:2007-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA35483207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A354830Medicaid
CAA84779Medicare UPIN
CA00A354830Medicaid