MEDICARE: ALOKE KUMAR MANDAL M.D., PH.D.

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	204F00000X	Transplant Surgery Physician	G87237	CA
2	208600000X	Surgery Physician	G87237	CA
3	2086X0206X	Surgical Oncology Physician	G87237	CA

General Provider Information

NPI Number	:	1417078882
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALOKE KUMAR MANDAL M.D., PH.D.

Provider Business Mailing Address
First Line	:	3110 W LAKE CENTER DR
Second Line	:	CA152-0243
City	:	SANTA ANA
State	:	CA
Zip	:	92704-6917
Country	:	US
Telephone Number	:	714-335-6624
Fax Number	:

Provider Business Practice Location Address
First Line	:	3110 W LAKE CENTER DR
Second Line	:	CA152-0243
City	:	SANTA ANA
State	:	CA
Zip	:	92704-6917
Country	:	US
Telephone Number	:	714-335-6624
Fax Number	:

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

Provider Enumeration Date	:	04/03/2007
Last Update Date	:	09/20/2016

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