=====================================================
General NPI Number Information
=====================================================
NPI Number | 1215146576
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | VINOD KUMAR GARG MD INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/22/2007
-----------------------------------------------------
Last Update Date | 02/26/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 250 W BONITA AVE STE 250
-----------------------------------------------------
City | POMONA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91767-1864
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 909-868-6800
-----------------------------------------------------
Fax | 909-256-2488
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 250 W BONITA AVE STE 250
-----------------------------------------------------
City | POMONA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91767-1864
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 909-868-6800
-----------------------------------------------------
Fax | 909-256-2488
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DOCTOR
-----------------------------------------------------
Name | DR. VINOD KUMAR GARG
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 909-868-6800
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number | A49049
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------