Healthcare Provider Details

I. General information

NPI: 1285703199
Provider Name (Legal Business Name): SATISH MUKUNDRAO KOLDHEKAR MS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/06/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8540 S SEPULVEDA BLVD # 104
LOS ANGELES CA
90045-3807
US

IV. Provider business mailing address

8540 S SEPULVEDA BLVD # 104
LOS ANGELES CA
90045-3807
US

V. Phone/Fax

Practice location:
  • Phone: 310-348-4700
  • Fax: 310-348-4703
Mailing address:
  • Phone: 310-348-4700
  • Fax: 310-348-4703

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License NumberHA3333
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: