Organization
KISHORE K VASANT MEDICAL GROUP INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KISHORE K VASANT M.D. (CEO)
(951) 698-8876
Entity
Organization
Contact information
Practice address
36450 INLAND VALLEY DR, SUITE # 116, WILDOMAR, CA 92595-9583
(951) 698-8876
(951) 698-5560
Mailing address
36450 INLAND VALLEY DR, SUITE # 116, WILDOMAR, CA 92595-9583
(951) 698-8876
(951) 698-5560
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
A33638
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00A336380
—
CA
Enumeration date
06/23/2006
Last updated
08/22/2020
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