Healthcare Provider Details

I. General information

NPI: 1124518626
Provider Name (Legal Business Name): TYAG KAMAL PATEL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/10/2018
Last Update Date: 10/20/2025
Certification Date: 10/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2700 LOW CT
FAIRFIELD CA
94534-9715
US

IV. Provider business mailing address

2700 LOW CT
FAIRFIELD CA
94534-9715
US

V. Phone/Fax

Practice location:
  • Phone: 707-427-4900
  • Fax:
Mailing address:
  • Phone: 707-427-4900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberA196270
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: