MEDICARE: DR. KULENDU GHANSHYAM VASAVDA M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	A49048	CA

General Provider Information

NPI Number	:	1245443654
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KULENDU GHANSHYAM VASAVDA M.D.

Provider Business Mailing Address
First Line	:	221 TUXEDO CT
Second Line	:	SUITE C
City	:	STOCKTON
State	:	CA
Zip	:	95204-5261
Country	:	US
Telephone Number	:	209-941-0149
Fax Number	:	209-941-2550

Provider Business Practice Location Address
First Line	:	221 TUXEDO CT
Second Line	:	SUITE C
City	:	STOCKTON
State	:	CA
Zip	:	95204-5261
Country	:	US
Telephone Number	:	209-941-0149
Fax Number	:	209-941-2550

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/08/2007
Last Update Date	:	01/29/2026

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