Healthcare Provider Details

I. General information

NPI: 1053932210
Provider Name (Legal Business Name): DEEPAK VIJAYAN NAIR MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/29/2020
Last Update Date: 11/11/2025
Certification Date: 11/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1433 N ACACIA AVE
REEDLEY CA
93654-2102
US

IV. Provider business mailing address

2072 DALI LN
CLOVIS CA
93611-6196
US

V. Phone/Fax

Practice location:
  • Phone: 559-391-3100
  • Fax:
Mailing address:
  • Phone: 715-897-5877
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA187051
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: