Basic Information
| Provider Information | |||||||||
| NPI: | 1205338662 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KOIRALA | ||||||||
| FirstName: | AAKASH | ||||||||
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| Mailing Information | |||||||||
| Address1: | 510 S MADERA AVE | ||||||||
| Address2: | |||||||||
| City: | MADERA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 936375552 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5598710070 | ||||||||
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| Practice Location | |||||||||
| Address1: | 344 E 6TH ST | ||||||||
| Address2: | |||||||||
| City: | MADERA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 936383631 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5596644000 | ||||||||
| FaxNumber: | 5596755224 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/01/2018 | ||||||||
| LastUpdateDate: | 03/01/2018 | ||||||||
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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 | 106S00000X | Y |
ID Information
| ID | Type | State | Issuer | Description | 92865152F67131 | 05 | CA | MEDICAID |