Provider Demographics
NPI:1982619359
Name:ASSOMULL, VINOD M SR (MD)
Entity Type:Individual
Prefix:DR
First Name:VINOD
Middle Name:M
Last Name:ASSOMULL
Suffix:SR
Gender:M
Credentials:MD
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Mailing Address - Street 1:16809 OAK VIEW DR
Mailing Address - Street 2:
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91436-3239
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:10605 BALBOA BLVD
Practice Address - Street 2:240
Practice Address - City:GRANADA HILLS
Practice Address - State:CA
Practice Address - Zip Code:91344-6342
Practice Address - Country:US
Practice Address - Phone:661-254-0193
Practice Address - Fax:661-254-2248
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2014-01-28
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAA31336207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA26443Medicare UPIN