Healthcare Provider Details

I. General information

NPI: 1134217813
Provider Name (Legal Business Name): HEMMAL S KOTHARY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/10/2006
Last Update Date: 10/14/2024
Certification Date: 10/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9500 STOCKDALE HWY STE 200
BAKERSFIELD CA
93311-3621
US

IV. Provider business mailing address

3400 DATA DR
RANCHO CORDOVA CA
95670-7956
US

V. Phone/Fax

Practice location:
  • Phone: 661-327-1431
  • Fax: 661-654-8340
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA76603
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: