NPIMap

Organization Active NPI

Vijay C Katukota, a Medical Corporation

  • Obstetrics & Gynecology Physician
  • Pomona, CA
National Provider Identifier
1760545503
Registry record updated Nov 4, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Obstetrics & Gynecology PhysicianTaxonomy code 207V00000X
License
A38343 Issued in CA
Legal business name
VIJAY C KATUKOTA, A MEDICAL CORPORATION
Practice address
1177 N Park Ave
Pomona, CA 91768-3028
Phone
(909) 623-9900
Fax
(909) 623-1993
NPI assigned
Dec 19, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 4, 2010

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Vijay Chandra Katukota, M.D.
Title
Medical Director
Phone
(909) 623-9900

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Obstetrics & Gynecology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207V00000X A38343 CA Primary

Addresses

Primary practice location

1177 N Park Ave
Pomona, CA 91768-3028

Mailing address

1177 N Park Ave
Pomona, CA 91768-3028
Phone (909) 623-9900

Other identifiers 1

IdentifierTypeStateIssuer
00A383430MedicaidCA

Other names 1

  • VIJAY C. KATUKOTA,, A MEDICAL CORPORATION Other name

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
05D0958816Vijay C Katukota, a Medical Corporation1177 N Park Avenue, Pomona, CA 91768Certificate of waiverMar 25, 2027

National Provider Directory

National Provider Directory

Locations

1177 N Park Ave
Pomona, CA 91768
Phone (909) 623-9900

Practitioners & affiliated clinicians

Practitioners 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1166486400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1288828800000",
    "number": "1760545503",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1177 N PARK AVE",
            "city": "POMONA",
            "state": "CA",
            "postal_code": "917683028",
            "telephone_number": "909-623-9900",
            "fax_number": "909-623-1993"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1177 N PARK AVE",
            "city": "POMONA",
            "state": "CA",
            "postal_code": "917683028",
            "telephone_number": "909-623-9900",
            "fax_number": "909-623-1993"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VIJAY C KATUKOTA, A MEDICAL CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-19",
        "last_updated": "2010-11-04",
        "status": "A",
        "authorized_official_last_name": "KATUKOTA",
        "authorized_official_first_name": "VIJAY",
        "authorized_official_middle_name": "CHANDRA",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "909-623-9900",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207V00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Obstetrics & Gynecology",
            "state": "CA",
            "license": "A38343",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00A383430",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "VIJAY C. KATUKOTA,, A MEDICAL CORPORATION",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Pomona, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 4, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.