Healthcare Provider Details

I. General information

NPI: 1306778675
Provider Name (Legal Business Name): STMJRR PROFESSIONAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/01/2026
Last Update Date: 06/01/2026
Certification Date: 06/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1141 W REDONDO BEACH BLVD STE 306
GARDENA CA
90247-3583
US

IV. Provider business mailing address

1141 W REDONDO BEACH BLVD STE 306
GARDENA CA
90247-3583
US

V. Phone/Fax

Practice location:
  • Phone: 310-834-5388
  • Fax: 909-563-1355
Mailing address:
  • Phone: 310-834-5388
  • Fax: 909-563-1355

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: SHRIKANT TAMHANE
Title or Position: DO
Credential: DO
Phone: 310-779-0515