Healthcare Provider Details

I. General information

NPI: 1851497499
Provider Name (Legal Business Name): AVINASH M MONDAR MD A MEDICAL CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/14/2006
Last Update Date: 11/19/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8641 WILSHIRE BLVD STE 220
BEVERLY HILLS CA
90211-2920
US

IV. Provider business mailing address

8641 WILSHIRE BLVD STE 220
BEVERLY HILLS CA
90211-2920
US

V. Phone/Fax

Practice location:
  • Phone: 310-657-1995
  • Fax: 310-657-5311
Mailing address:
  • Phone: 310-657-1995
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberA35142
License Number StateCA

VIII. Authorized Official

Name: DR. AVINASH M. MONDKAR
Title or Position: PRESIDENT
Credential: M.D.
Phone: 310-657-1995