Healthcare Provider Details

I. General information

NPI: 1003843863
Provider Name (Legal Business Name): CHOUDHARY BALWAN S. PATEL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2006
Last Update Date: 09/17/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4525 E ATHERTON ST
LONG BEACH CA
90815-3700
US

IV. Provider business mailing address

4525 E ATHERTON ST
LONG BEACH CA
90815-3700
US

V. Phone/Fax

Practice location:
  • Phone: 562-961-0155
  • Fax:
Mailing address:
  • Phone: 562-961-0155
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number35039
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberC127780
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: