MEDICARE: DR. MIRALI PANDYA BDS, PHD, MS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223P0300X	Periodontics	SP322	CA

General Provider Information

NPI Number	:	1215608633
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MIRALI PANDYA BDS, PHD, MS

Provider Business Mailing Address
First Line	:	1201 S HOPE ST APT 1120
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90015-4694
Country	:	US
Telephone Number	:	972-408-7673
Fax Number	:

Provider Business Practice Location Address
First Line	:	1034 W 34TH ST #401
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90089-0001
Country	:	US
Telephone Number	:	213-740-2012
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/24/2021
Last Update Date	:	02/12/2025

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