Healthcare Provider Details

I. General information

NPI: 1841248549
Provider Name (Legal Business Name): UMAKANT M KHETAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2006
Last Update Date: 10/05/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1245 WILSHIRE BLVD STE 306
LOS ANGELES CA
90017-4803
US

IV. Provider business mailing address

1718 LILA LN
LA CANADA CA
91011-1647
US

V. Phone/Fax

Practice location:
  • Phone: 323-721-9411
  • Fax:
Mailing address:
  • Phone: 818-790-2513
  • Fax: 626-281-4536

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberA38780
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: