Healthcare Provider Details

I. General information

NPI: 1023554128
Provider Name (Legal Business Name): SHRIKANT TAMHANE, DO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/12/2017
Last Update Date: 01/12/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23517 MAIN ST SUITE 103
CARSON CA
90745-5251
US

IV. Provider business mailing address

23517 MAIN ST SUITE 103
CARSON CA
90745-5251
US

V. Phone/Fax

Practice location:
  • Phone: 714-865-0263
  • Fax: 714-660-6106
Mailing address:
  • Phone: 714-865-0263
  • Fax: 714-660-6106

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: SUNANDA BHATIA
Title or Position: MANAGER
Credential:
Phone: 714-865-0263