Provider Demographics
NPI:1770554016
Name:BHAN, VINOD C (CRNA)
Entity type:Individual
Prefix:MR
First Name:VINOD
Middle Name:C
Last Name:BHAN
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:940 SYLVA LANE STE G
Mailing Address - Street 2:
Mailing Address - City:SONORA
Mailing Address - State:CA
Mailing Address - Zip Code:95370-5969
Mailing Address - Country:US
Mailing Address - Phone:209-532-0340
Mailing Address - Fax:209-532-6405
Practice Address - Street 1:940 SYLVA LN
Practice Address - Street 2:SUITE G
Practice Address - City:SONORA
Practice Address - State:CA
Practice Address - Zip Code:95370-5969
Practice Address - Country:US
Practice Address - Phone:209-532-0340
Practice Address - Fax:209-532-6405
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-26
Last Update Date:2023-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARN651476367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAP00283966OtherRAILROAD MEDICARE
CA430005737OtherRAILROAD MEDICARE
CARN2995960OtherNURSE ANESTHETIST
CARN2995960Medicaid
CARN2995960OtherNURSE ANESTHETIST
CAZZZ03627ZMedicare PIN