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General NPI Number Information
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NPI Number | 1396063970
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Entity Type | Organization
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Legal Business Name | KRUNAL J MEHTA MD INC
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Dates
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Enumeration Date | 05/06/2010
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Last Update Date | 07/31/2015
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Provider Practice Location Address
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Address Line | 130 W ROUTE 66 SUITE 214
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City | GLENDORA
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State | CA
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Zip | 91740-6249
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Country | US
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Telephone | 626-335-4129
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Fax | 626-335-6177
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Provider Business Mailing Address
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Address Line | 130 W ROUTE 66 SUITE 214
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City | GLENDORA
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State | CA
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Zip | 91740-6249
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Country | US
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Telephone | 626-335-4129
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Fax | 626-335-6177
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Authorized Official
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Title or Position | PRESIDENT
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Name | KRUNAL J MEHTA
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Credential | MD
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Telephone | 626-335-4129
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | A110016
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License Number State | CA
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