Provider Demographics
NPI:1902086341
Name:VIJAY THUKRAL, MD, A PROFESSIONAL CORP.
Entity Type:Organization
Organization Name:VIJAY THUKRAL, MD, A PROFESSIONAL CORP.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:VIJAY
Authorized Official - Middle Name:K
Authorized Official - Last Name:THUKRAL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:408-258-7400
Mailing Address - Street 1:995 MONTAGUE EXPY
Mailing Address - Street 2:SUITE #213
Mailing Address - City:MILPITAS
Mailing Address - State:CA
Mailing Address - Zip Code:95035-6851
Mailing Address - Country:US
Mailing Address - Phone:408-258-7400
Mailing Address - Fax:408-258-2175
Practice Address - Street 1:995 MONTAGUE EXPY
Practice Address - Street 2:SUITE #213
Practice Address - City:MILPITAS
Practice Address - State:CA
Practice Address - Zip Code:95035-6851
Practice Address - Country:US
Practice Address - Phone:408-258-7400
Practice Address - Fax:408-258-2175
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-13
Last Update Date:2009-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA00A423070261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
CABX561AMedicare PIN
CA00A423070Medicare UPIN