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General NPI Number Information
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NPI Number | 1154495307
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Entity Type | Organization
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Legal Business Name | MERCY EYE CARE MEDICAL GROUP INC
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Dates
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Enumeration Date | 11/20/2006
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Last Update Date | 01/24/2012
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Provider Practice Location Address
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Address Line | 1717 W BEVERLY BLVD STE A
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City | MONTEBELLO
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State | CA
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Zip | 90640-3971
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Country | US
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Telephone | 323-724-1075
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Fax | 323-724-1198
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Provider Business Mailing Address
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Address Line | 1700 E CESAR E CHAVEZ AVE STE 3400
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City | LOS ANGELES
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State | CA
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Zip | 90033-2469
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Country | US
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Telephone | 323-526-7273
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Fax | 323-526-7235
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Authorized Official
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Title or Position | PRESIDENT
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Name | SANDEEP K KHANNA
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Credential | M.D.
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Telephone | 323-526-7235
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | A48969
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License Number State | CA
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