Healthcare Provider Details

I. General information

NPI: 1366538993
Provider Name (Legal Business Name): VAIJAYANTI S KOLDHEKAR MD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/04/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

931 BUENA VISTA # 302
DUARTE CA
91010
US

IV. Provider business mailing address

931 BUENA VISTA # 302
DUARTE CA
91010
US

V. Phone/Fax

Practice location:
  • Phone: 626-303-2541
  • Fax: 626-358-5572
Mailing address:
  • Phone: 626-303-2541
  • Fax: 626-358-5572

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA43547
License Number StateCA

VIII. Authorized Official

Name: MRS. VAIJAYANTI S KOLDHEKAR
Title or Position: PRESIDENT
Credential: MD
Phone: 626-303-2541