Healthcare Provider Details

I. General information

NPI: 1588620363
Provider Name (Legal Business Name): ATUL MADAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/21/2006
Last Update Date: 04/15/2025
Certification Date: 04/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1310 W STEWART DR STE 310
ORANGE CA
92868-3838
US

IV. Provider business mailing address

10573 W PICO BLVD # 859
LOS ANGELES CA
90064-2333
US

V. Phone/Fax

Practice location:
  • Phone: 562-270-5411
  • Fax: 424-248-0985
Mailing address:
  • Phone: 310-869-7776
  • Fax: 866-933-0664

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberC53803
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code2083B0002X
TaxonomyObesity Medicine (Preventive Medicine) Physician
License NumberC53803
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code2086P0122X
TaxonomyPhysician Nutrition Specialist (Surgery)
License NumberC53803
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: