Healthcare Provider Details

I. General information

NPI: 1477509529
Provider Name (Legal Business Name): ANJANI KUMAR THAKUR M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/26/2006
Last Update Date: 02/25/2025
Certification Date: 02/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

840 DELBON AVE
TURLOCK CA
95382-2005
US

IV. Provider business mailing address

220 STANDIFORD AVE F
MODESTO CA
95350-1159
US

V. Phone/Fax

Practice location:
  • Phone: 209-656-7400
  • Fax: 209-656-7418
Mailing address:
  • Phone: 209-579-5628
  • Fax: 209-579-5637

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberA66588
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberA66588
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License NumberA66588
License Number StateCA
# 4
Primary TaxonomyY
Taxonomy Code202K00000X
TaxonomyPhlebology Physician
License NumberA66588
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: