Provider Demographics
NPI:1740349372
Name:KOKA, VIDHYALAKSHMI (MD)
Entity type:Individual
Prefix:
First Name:VIDHYALAKSHMI
Middle Name:
Last Name:KOKA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:VIDHYALAKSHMI
Other - Middle Name:
Other - Last Name:TAYI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:422 N SAN JACINTO ST
Mailing Address - Street 2:
Mailing Address - City:HEMET
Mailing Address - State:CA
Mailing Address - Zip Code:92543-3124
Mailing Address - Country:US
Mailing Address - Phone:941-665-1100
Mailing Address - Fax:888-696-2590
Practice Address - Street 1:422 N SAN JACINTO ST
Practice Address - Street 2:
Practice Address - City:HEMET
Practice Address - State:CA
Practice Address - Zip Code:92543-3124
Practice Address - Country:US
Practice Address - Phone:941-665-1100
Practice Address - Fax:888-696-2590
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-08
Last Update Date:2021-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA60821208000000X, 208D00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice