Healthcare Provider Details

I. General information

NPI: 1023346277
Provider Name (Legal Business Name): RAKESH KUMAR BHOLA ,M.D. INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/30/2009
Last Update Date: 07/25/2024
Certification Date: 07/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1781 W ROMNEYA DR STE C
ANAHEIM CA
92801-1818
US

IV. Provider business mailing address

1781 W ROMNEYA DR STE C
ANAHEIM CA
92801-1818
US

V. Phone/Fax

Practice location:
  • Phone: 714-776-2700
  • Fax:
Mailing address:
  • Phone: 714-776-2700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: RAKESH KUMAR BHOLA
Title or Position: PRESIDENT
Credential: M.D.
Phone: 714-776-2700