Provider Demographics
NPI:1245370105
Name:POPAT, KISHOR D (M D)
Entity type:Individual
Prefix:
First Name:KISHOR
Middle Name:D
Last Name:POPAT
Suffix:
Gender:M
Credentials:M D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1505 SHEPARD DR
Mailing Address - Street 2:SUITE 203
Mailing Address - City:SANTA MARIA
Mailing Address - State:CA
Mailing Address - Zip Code:93454-7020
Mailing Address - Country:US
Mailing Address - Phone:805-922-6990
Mailing Address - Fax:805-347-9920
Practice Address - Street 1:1505 SHEPARD DR
Practice Address - Street 2:SUITE 203
Practice Address - City:SANTA MARIA
Practice Address - State:CA
Practice Address - Zip Code:93454-7020
Practice Address - Country:US
Practice Address - Phone:805-922-6990
Practice Address - Fax:805-347-9920
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA 39601174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA 39601OtherSTATE LICENSE