Healthcare Provider Details

I. General information

NPI: 1144114109
Provider Name (Legal Business Name): KISAN PATEL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/04/2025
Last Update Date: 05/22/2026
Certification Date: 05/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3255 WILSHIRE BLVD STE 100
LOS ANGELES CA
90010-1404
US

IV. Provider business mailing address

4627 VIRO RD
LA CANADA FLINTRIDGE CA
91011-3741
US

V. Phone/Fax

Practice location:
  • Phone: 213-235-1203
  • Fax:
Mailing address:
  • Phone: 626-466-8086
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: