Provider Demographics
NPI:1952401960
Name:SHARMA, KAVITA (MD)
Entity Type:Individual
Prefix:
First Name:KAVITA
Middle Name:
Last Name:SHARMA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2386 BENTLEY RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95138-2435
Mailing Address - Country:US
Mailing Address - Phone:530-294-1136
Mailing Address - Fax:530-294-1143
Practice Address - Street 1:221 E HACIENDA AVE
Practice Address - Street 2:SUITE D
Practice Address - City:CAMPBELL
Practice Address - State:CA
Practice Address - Zip Code:95008-6625
Practice Address - Country:US
Practice Address - Phone:408-376-3380
Practice Address - Fax:408-376-3801
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-22
Last Update Date:2022-12-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA71740207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAH29311Medicare UPIN