Healthcare Provider Details

I. General information

NPI: 1447498225
Provider Name (Legal Business Name): VIJAY S VAIDYA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/02/2009
Last Update Date: 06/01/2026
Certification Date: 06/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8536 WILSHIRE BLVD STE 200
BEVERLY HILLS CA
90211-3154
US

IV. Provider business mailing address

8536 WILSHIRE BLVD STE 200
BEVERLY HILLS CA
90211-3154
US

V. Phone/Fax

Practice location:
  • Phone: 310-248-8300
  • Fax:
Mailing address:
  • Phone: 310-248-8300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number251274
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number61528
License Number StateKY
# 3
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberA100369
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: