Provider Demographics
NPI:1255426599
Name:NAIK, TEJASKUMAR A (MD)
Entity type:Individual
Prefix:
First Name:TEJASKUMAR
Middle Name:A
Last Name:NAIK
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 1:2083 COMPTON AVE
Mailing Address - Street 2:SUITE 103
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92881-7283
Mailing Address - Country:US
Mailing Address - Phone:951-372-0039
Mailing Address - Fax:951-372-0180
Practice Address - Street 1:2083 COMPTON AVE
Practice Address - Street 2:SUITE 103
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92881-7283
Practice Address - Country:US
Practice Address - Phone:951-372-0039
Practice Address - Fax:951-372-0180
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2011-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC51412207R00000X, 207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00C514120Medicaid
H08096Medicare UPIN
CA00C514120Medicaid