Provider Demographics
NPI:1790708782
Name:GARG, VIJAY K (MD)
Entity Type:Individual
Prefix:
First Name:VIJAY
Middle Name:K
Last Name:GARG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:142 MACAW LN
Mailing Address - Street 2:
Mailing Address - City:SIMI VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:93065-3152
Mailing Address - Country:US
Mailing Address - Phone:805-522-3811
Mailing Address - Fax:805-522-2115
Practice Address - Street 1:142 MACAW LN
Practice Address - Street 2:
Practice Address - City:SIMI VALLEY
Practice Address - State:CA
Practice Address - Zip Code:93065-3152
Practice Address - Country:US
Practice Address - Phone:805-522-3811
Practice Address - Fax:805-522-2115
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2011-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA35932207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
060004628OtherRAILROAD MEDICARE
CA00A359320Medicaid
CA00A359320Medicaid
060004628OtherRAILROAD MEDICARE