Healthcare Provider Details

I. General information

NPI: 1932582699
Provider Name (Legal Business Name): AKSHAY MEHTA MD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/30/2015
Last Update Date: 06/30/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4305 TORRANCE BLVD SUITE #109
TORRANCE CA
90503-4421
US

IV. Provider business mailing address

PO BOX 3129
TORRANCE CA
90510-3129
US

V. Phone/Fax

Practice location:
  • Phone: 310-406-3900
  • Fax: 310-406-3902
Mailing address:
  • Phone: 310-792-3914
  • Fax: 855-898-4055

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberA113544
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License NumberA113544
License Number StateCA

VIII. Authorized Official

Name: AKSHAY MEHTA
Title or Position: PRESIDENT & FOUNDER
Credential: M.D.
Phone: 310-792-3914