Basic Information
| Provider Information | |||||||||
| NPI: | 1134217813 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KOTHARY | ||||||||
| FirstName: | HEMMAL | ||||||||
| MiddleName: | S | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3400 DATA DR | ||||||||
| Address2: | QUALITY MANAGEMENT | ||||||||
| City: | RANCHO CORDOVA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 956707956 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 9500 STOCKDALE HWY | ||||||||
| Address2: | STE 200 | ||||||||
| City: | BAKERSFIELD | ||||||||
| State: | CA | ||||||||
| PostalCode: | 933113620 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6613271431 | ||||||||
| FaxNumber: | 6616548340 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/10/2006 | ||||||||
| LastUpdateDate: | 01/06/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | A76603 | CA | Y | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | DEABK7701293 | CA | N | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | ZZZ01707Z | 01 | MEDICARE GROUP ID# | OTHER |