Healthcare Provider Details

I. General information

NPI: 1114952488
Provider Name (Legal Business Name): MONICA P KANDAVEL M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2006
Last Update Date: 12/08/2021
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18370 BURBANK BLVD SUITE 307
TARZANA CA
91356-2804
US

IV. Provider business mailing address

18370 BURBANK BLVD SUITE 307
TARZANA CA
91356-2804
US

V. Phone/Fax

Practice location:
  • Phone: 818-996-6000
  • Fax: 818-996-4712
Mailing address:
  • Phone: 818-996-6000
  • Fax: 818-996-4712

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA84903
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: