Healthcare Provider Details

I. General information

NPI: 1336019744
Provider Name (Legal Business Name): LL MEDICAL CLINIC CA PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/10/2025
Last Update Date: 11/10/2025
Certification Date: 11/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1325 J ST STE 1550
SACRAMENTO CA
95814-2976
US

IV. Provider business mailing address

1325 J ST STE 1550
SACRAMENTO CA
95814-2976
US

V. Phone/Fax

Practice location:
  • Phone: 646-877-3138
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

Name: ROSHNI SANGHVI
Title or Position: OPERATIONS
Credential: PA-C
Phone: 646-887-3138