Basic Information
| Provider Information | |||||||||
| NPI: | 1073654570 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | VAIDYA | ||||||||
| FirstName: | CHIRAG | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1869 | ||||||||
| Address2: | |||||||||
| City: | UPLAND | ||||||||
| State: | CA | ||||||||
| PostalCode: | 917851869 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9099815882 | ||||||||
| FaxNumber: | 9099460833 | ||||||||
| Practice Location | |||||||||
| Address1: | 1317 W FOOTHILL BLVD | ||||||||
| Address2: | STE 148 | ||||||||
| City: | UPLAND | ||||||||
| State: | CA | ||||||||
| PostalCode: | 917863676 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9099815882 | ||||||||
| FaxNumber: | 9099460833 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/09/2007 | ||||||||
| LastUpdateDate: | 08/02/2016 | ||||||||
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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 | 233518 | MA | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207RN0300X | A111164 | CA | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Nephrology |
No ID Information.