Healthcare Provider Details

I. General information

NPI: 1013156843
Provider Name (Legal Business Name): PULIN A SHETH MD, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/18/2009
Last Update Date: 02/18/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

211 N PRAIRIE AVE
INGLEWOOD CA
90301-1412
US

IV. Provider business mailing address

7005 KENTWOOD CT
LOS ANGELES CA
90045-1264
US

V. Phone/Fax

Practice location:
  • Phone: 310-672-9729
  • Fax:
Mailing address:
  • Phone: 310-431-7030
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0206X
TaxonomyMammography Clinic/Center
License NumberG81342
License Number StateCA

VIII. Authorized Official

Name: DR. PULIN A SHETH
Title or Position: PRESIDENT
Credential: M.D.
Phone: 310-431-7030