Provider Demographics
NPI:1043244122
Name:JOHN, THAMPI (MD)
Entity type:Individual
Prefix:
First Name:THAMPI
Middle Name:
Last Name:JOHN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 RIVER PARK PL W STE 330
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93720-1547
Mailing Address - Country:US
Mailing Address - Phone:559-434-6232
Mailing Address - Fax:559-256-2452
Practice Address - Street 1:30 RIVER PARK PL W
Practice Address - Street 2:STE 330
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93720-1545
Practice Address - Country:US
Practice Address - Phone:559-434-6232
Practice Address - Fax:559-256-2452
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA52031207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAOOA520310Medicaid
CAOOA520312Medicare ID - Type Unspecified
CAG22124Medicare UPIN