Provider Demographics
NPI:1851370928
Name:KARNAVY, VICHIEN K (MD)
Entity Type:Individual
Prefix:
First Name:VICHIEN
Middle Name:K
Last Name:KARNAVY
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 1:300 E 7TH ST
Mailing Address - Street 2:2 E
Mailing Address - City:UPLAND
Mailing Address - State:CA
Mailing Address - Zip Code:91786
Mailing Address - Country:US
Mailing Address - Phone:909-982-8976
Mailing Address - Fax:909-920-3176
Practice Address - Street 1:300 E 7TH ST
Practice Address - Street 2:SUITE 2 E
Practice Address - City:UPLAND
Practice Address - State:CA
Practice Address - Zip Code:91786
Practice Address - Country:US
Practice Address - Phone:909-982-8976
Practice Address - Fax:909-920-3176
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA34414208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A344140Medicaid
CA00A344140Medicaid
A27475Medicare UPIN