Healthcare Provider Details

I. General information

NPI: 1497840748
Provider Name (Legal Business Name): SHRIKANT TAMHANE, DO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 01/30/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23517 MAIN ST STE 103
CARSON CA
90745-5234
US

IV. Provider business mailing address

28928 CRESTRIDGE RD
RANCHO PALOS VERDES CA
90275-5061
US

V. Phone/Fax

Practice location:
  • Phone: 310-339-4011
  • Fax:
Mailing address:
  • Phone: 310-339-4011
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number20A7213
License Number StateCA

VIII. Authorized Official

Name: SHRIKANT TAMHANE
Title or Position: OWNER
Credential: D.O.
Phone: 310-339-4011