Healthcare Provider Details

I. General information

NPI: 1285991349
Provider Name (Legal Business Name): VINOD K. KAURA, M D A PROFESSIONAL CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/13/2012
Last Update Date: 05/10/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 WESTERN AVE SUITE 303
SAN BERNARDINO CA
92411-1356
US

IV. Provider business mailing address

1800 WESTERN AVE SUITE 303
SAN BERNARDINO CA
92411-1356
US

V. Phone/Fax

Practice location:
  • Phone: 909-887-6715
  • Fax: 909-887-3296
Mailing address:
  • Phone: 909-887-6715
  • Fax: 909-887-3296

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: VINOD K KAURA
Title or Position: PRESIDENT
Credential: M.D.
Phone: 909-887-6715