1518977685 NPI number — SUNIL GOPAL BHANDARKAR M.D.

Table of content: SUNIL GOPAL BHANDARKAR M.D. (NPI 1518977685)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1518977685 NPI number — SUNIL GOPAL BHANDARKAR M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BHANDARKAR
Provider First Name:
SUNIL
Provider Middle Name:
GOPAL
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
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:
1518977685
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/07/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2200 COLORADO AVE
Provider Second Line Business Mailing Address:
APT #516
Provider Business Mailing Address City Name:
SANTA MONICA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90404-3571
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
310-828-0721
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
321 N LARCHMONT BLVD
Provider Second Line Business Practice Location Address:
SUITE #700
Provider Business Practice Location Address City Name:
LOS ANGELES
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90004-6407
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-467-7161
Provider Business Practice Location Address Fax Number:
323-467-3922
Provider Enumeration Date:
08/09/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207W00000X , with the licence number:  A91354 , 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: A91354 . This is a "STATE LICENSE" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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