Individual
JAYAKUMAR RAVICHANDRAN VIDHUN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
12462 PUTNAM ST., SUITE 506, WHITTIER, CA 90602-1002
(562) 698-8141
(562) 698-9885
Mailing address
P.O. BOX 511, WHITTIER, CA 90608-0511
(562) 698-8141
(562) 698-9885
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
A92267
CA
207RN0300X
Nephrology Physician
Primary
A92267
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00A922670
—
CA
Enumeration date
01/17/2007
Last updated
11/15/2013
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