Healthcare Provider Details

I. General information

NPI: 1497868251
Provider Name (Legal Business Name): SHRIKANT TAMHANE D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/16/2006
Last Update Date: 05/15/2017
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

125 N. GALE DRIVE UNIT 404
BEVERLY HILLS CA
90211
US

V. Phone/Fax

Practice location:
  • Phone: 310-834-5388
  • Fax:
Mailing address:
  • Phone: 310-779-0515
  • Fax: 310-834-5619

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:
Title or Position:
Credential:
Phone: