Healthcare Provider Details

I. General information

NPI: 1780009936
Provider Name (Legal Business Name): HEMANT UPADHYAYA, M.D. INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/25/2014
Last Update Date: 02/25/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1941 HUNTINGTON DR STE C
SOUTH PASADENA CA
91030-4994
US

IV. Provider business mailing address

1941 HUNTINGTON DR STE C
SOUTH PASADENA CA
91030-4994
US

V. Phone/Fax

Practice location:
  • Phone: 626-799-7127
  • Fax: 626-799-7570
Mailing address:
  • Phone: 626-799-7127
  • Fax: 626-799-7570

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA44897
License Number StateCA

VIII. Authorized Official

Name: HEMANT B UPADHYAYA
Title or Position: OWNER / PHYSICIAN
Credential: M.D.
Phone: 626-799-7127