Healthcare Provider Details

I. General information

NPI: 1598860645
Provider Name (Legal Business Name): MRIDULA KEDIA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/13/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4201 TORRANCE BLVD STE 740
TORRANCE CA
90503-4521
US

IV. Provider business mailing address

1746 GATES AVE
MANHATTAN BEACH CA
90266-7031
US

V. Phone/Fax

Practice location:
  • Phone: 310-540-5676
  • Fax: 310-543-3092
Mailing address:
  • Phone: 310-798-8145
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA43406
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: