Healthcare Provider Details

I. General information

NPI: 1164870499
Provider Name (Legal Business Name): KARTHIKEYAN BHUVANESWARAN DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/26/2016
Last Update Date: 09/14/2023
Certification Date: 09/14/2023
Deactivation Date: 03/13/2018
Reactivation Date: 06/14/2018

III. Provider practice location address

7601 IMPERIAL HWY
DOWNEY CA
90242-3456
US

IV. Provider business mailing address

11873 VALLEY VIEW ST UNIT 1065
GARDEN GROVE CA
92845-1236
US

V. Phone/Fax

Practice location:
  • Phone: 562-385-6468
  • Fax:
Mailing address:
  • Phone: 802-327-3422
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081N0008X
TaxonomyNeuromuscular Medicine (Physical Medicine & Rehabilitation) Physician
License Number15848
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: