Healthcare Provider Details

I. General information

NPI: 1801292701
Provider Name (Legal Business Name): VIJAI DANIEL MD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/05/2014
Last Update Date: 01/11/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1660 E HERNDON AVE SUITE 101
FRESNO CA
93720-3359
US

IV. Provider business mailing address

1660 E HERNDON AVE SUITE 101
FRESNO CA
93720-3359
US

V. Phone/Fax

Practice location:
  • Phone: 559-431-9753
  • Fax:
Mailing address:
  • Phone: 559-431-9753
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License NumberC55861
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License NumberC55861
License Number StateCA

VIII. Authorized Official

Name: VIJAI DANIEL
Title or Position: OWNER
Credential: M.D.
Phone: 559-241-9051