Healthcare Provider Details

I. General information

NPI: 1508880659
Provider Name (Legal Business Name): ASHISH HARJI KALTHIA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/26/2006
Last Update Date: 11/29/2023
Certification Date: 11/29/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12665 GARDEN GROVE BLVD STE 211
GARDEN GROVE CA
92843-1916
US

IV. Provider business mailing address

12665 GARDEN GROVE BLVD STE 211
GARDEN GROVE CA
92843-1916
US

V. Phone/Fax

Practice location:
  • Phone: 714-636-2890
  • Fax: 714-636-2909
Mailing address:
  • Phone: 714-636-2890
  • Fax: 714-636-2909

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberA78472
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: