1093848673 NPI number — RAMESH MULCHANDANI DDS

Table of content: (NPI 1093848673)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1093848673 NPI number — RAMESH MULCHANDANI DDS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RAMESH MULCHANDANI DDS
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
R M MULCHANDANI DDS
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1093848673
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/17/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
12060 S CENTRAL AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LOS ANGELES
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90059-2839
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
323-564-4417
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
12060 S CENTRAL AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LOS ANGELES
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90059-2839
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-564-4417
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/13/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
MULCHANDANI
Authorized Official First Name:
RAMESH
Authorized Official Middle Name:
Authorized Official Title or Position:
D.D.S
Authorized Official Telephone Number:
323-564-4417

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X , with the licence number:  29388 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: B 29388-01 . This is a "MEDI-CAL PROVIDER NUMBER" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: CGP168516 . This is a "CCS" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 29388 . This is a "DELTADENTAL" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".