Provider Demographics
NPI:1972559706
Name:THAKUR, VIJAYA (MD)
Entity Type:Individual
Prefix:DR
First Name:VIJAYA
Middle Name:
Last Name:THAKUR
Suffix:
Gender:F
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:PO BOX 3218
Mailing Address - Street 2:
Mailing Address - City:TURLOCK
Mailing Address - State:CA
Mailing Address - Zip Code:95381-3218
Mailing Address - Country:US
Mailing Address - Phone:209-668-2600
Mailing Address - Fax:209-668-2631
Practice Address - Street 1:840 DELBON AVE
Practice Address - Street 2:SUITE B
Practice Address - City:TURLOCK
Practice Address - State:CA
Practice Address - Zip Code:95382-2005
Practice Address - Country:US
Practice Address - Phone:209-668-2600
Practice Address - Fax:209-668-2631
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-25
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA79868207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A798680Medicaid
05773734OtherECFMG NUMBER
05773734OtherECFMG NUMBER
CA00A798680Medicare ID - Type Unspecified
05773734OtherECFMG NUMBER