Healthcare Provider Details

I. General information

NPI: 1477832277
Provider Name (Legal Business Name): TANJA L. KUJAC, MD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/10/2011
Last Update Date: 08/10/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

710 SOUTH BROADWAY STE 110
WALNUT CREEK CA
94596
US

IV. Provider business mailing address

PO BOX #183 3000 F DANVILLE BLVD
ALAMO CA
94507
US

V. Phone/Fax

Practice location:
  • Phone: 925-256-6583
  • Fax: 925-256-6583
Mailing address:
  • Phone: 925-256-6583
  • Fax: 925-256-6583

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081H0002X
TaxonomyHospice and Palliative Medicine (Physical Medicine & Rehabilitation) Physician
License NumberA063451
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code2081N0008X
TaxonomyNeuromuscular Medicine (Physical Medicine & Rehabilitation) Physician
License NumberA063451
License Number StateCA

VIII. Authorized Official

Name: DR. TANYA LYNNE KUJAC
Title or Position: CEO/MEDICAL DIRECTOR
Credential: MD
Phone: 925-256-6583