Healthcare Provider Details

I. General information

NPI: 1164107512
Provider Name (Legal Business Name): KAMLESH K SANKHALA MD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/21/2023
Last Update Date: 07/22/2024
Certification Date: 07/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9100 WILSHIRE BLVD STE 840W
BEVERLY HILLS CA
90212-3556
US

IV. Provider business mailing address

1171 S ROBERTSON BLVD # 145
LOS ANGELES CA
90035-1403
US

V. Phone/Fax

Practice location:
  • Phone: 424-777-0708
  • Fax:
Mailing address:
  • Phone: 310-908-0057
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332900000X
TaxonomyNon-Pharmacy Dispensing Site
License Number
License Number State

VIII. Authorized Official

Name: DR. KAMALESH K SANKHALA
Title or Position: PRESIDENT
Credential: MD
Phone: 310-908-0057