Provider Demographics
NPI:1841211497
Name:BHOOPAT, VICHAI (MD)
Entity Type:Individual
Prefix:
First Name:VICHAI
Middle Name:
Last Name:BHOOPAT
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 1:13492 GRINNELL CIR
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:CA
Mailing Address - Zip Code:92683-1734
Mailing Address - Country:US
Mailing Address - Phone:714-897-2735
Mailing Address - Fax:714-897-2735
Practice Address - Street 1:3801 KATELLA AVE STE 301
Practice Address - Street 2:
Practice Address - City:LOS ALAMITOS
Practice Address - State:CA
Practice Address - Zip Code:90720-3373
Practice Address - Country:US
Practice Address - Phone:562-493-4466
Practice Address - Fax:562-493-4466
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2012-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA25146207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAVOL000Medicare UPIN