Basic Information
| Provider Information | |||||||||
| NPI: | 1376533505 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | YAGNIK | ||||||||
| FirstName: | VIVEK | ||||||||
| MiddleName: | C. | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 12554 RIATA VISTA CIR | ||||||||
| Address2: | |||||||||
| City: | AUSTIN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 787276431 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5127955100 | ||||||||
| FaxNumber: | 5127955122 | ||||||||
| Practice Location | |||||||||
| Address1: | 12951 SOUTH FWY | ||||||||
| Address2: | |||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 770471923 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7135265771 | ||||||||
| FaxNumber: | 7135262036 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/27/2005 | ||||||||
| LastUpdateDate: | 07/11/2019 | ||||||||
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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 | 2085R0202X | K4343 | TX | Y | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
ID Information
| ID | Type | State | Issuer | Description | 045049603 | 05 | TX | MEDICAID | 045049605 | 05 | TX | MEDICAID |