MEDICARE: DR. VIMI R KAPUR M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	036-110505	IL
2	207L00000X	Anesthesiology Physician	A105170	CA

General Provider Information

NPI Number	:	1669590204
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. VIMI R KAPUR M.D.

Provider Business Mailing Address
First Line	:	PO BOX 780601
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19178-0601
Country	:	US
Telephone Number	:	800-863-2002
Fax Number	:	770-701-6811

Provider Business Practice Location Address
First Line	:	31700 TEMECULA PKWY
Second Line	:
City	:	TEMECULA
State	:	CA
Zip	:	92592-5896
Country	:	US
Telephone Number	:	951-331-2200
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/26/2007
Last Update Date	:	10/10/2019

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