Healthcare Provider Details

I. General information

NPI: 1588659247
Provider Name (Legal Business Name): SANJIV M KAUL DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/19/2005
Last Update Date: 06/22/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

840 S AKERS ST
VISALIA CA
93277-8309
US

IV. Provider business mailing address

PO BOX 6098
VISALIA CA
93290-6098
US

V. Phone/Fax

Practice location:
  • Phone: 559-624-3710
  • Fax: 559-635-4001
Mailing address:
  • Phone: 559-802-3635
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number20A11357
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: