Provider Demographics
NPI:1922105634
Name:KAMATH, NANDAN VASUDEV (MD)
Entity Type:Individual
Prefix:DR
First Name:NANDAN
Middle Name:VASUDEV
Last Name:KAMATH
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 1:941 MERCHANT ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:VACAVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95688-5315
Mailing Address - Country:US
Mailing Address - Phone:707-446-6969
Mailing Address - Fax:707-446-2775
Practice Address - Street 1:941 MERCHANT ST
Practice Address - Street 2:SUITE A
Practice Address - City:VACAVILLE
Practice Address - State:CA
Practice Address - Zip Code:95688-5315
Practice Address - Country:US
Practice Address - Phone:707-446-6969
Practice Address - Fax:707-446-2775
Is Sole Proprietor?:No
Enumeration Date:2006-09-17
Last Update Date:2008-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA87880207N00000X, 207NS0135X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural Dermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
I14261Medicare UPIN
CA00A878800Medicare PIN