Provider Demographics
NPI:1801999404
Name:VINAY K BUTTAN MD INC
Entity type:Organization
Organization Name:VINAY K BUTTAN MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:POONAM
Authorized Official - Middle Name:
Authorized Official - Last Name:BUTTAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:559-782-0581
Mailing Address - Street 1:166 N VILLA ST
Mailing Address - Street 2:
Mailing Address - City:PORTERVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:93257
Mailing Address - Country:US
Mailing Address - Phone:559-782-0581
Mailing Address - Fax:559-782-1163
Practice Address - Street 1:166 N VILLA ST
Practice Address - Street 2:
Practice Address - City:PORTERVILLE
Practice Address - State:CA
Practice Address - Zip Code:93257
Practice Address - Country:US
Practice Address - Phone:559-782-1990
Practice Address - Fax:559-782-1163
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-07
Last Update Date:2008-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA43173208000000X
CAA33656207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A431730Medicaid
CA00A336561Medicare PIN
CAA27214Medicare UPIN
CA00A431730Medicaid