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General NPI Number Information
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NPI Number | 1720243082
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Entity Type | Individual
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Provider Name | AJAY MANCHANDIA MD
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Gender | Male
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Dates
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Enumeration Date | 07/25/2008
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Last Update Date | 12/22/2023
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Provider Practice Location Address
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Address Line | 1120 W LA VETA AVE STE 100
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City | ORANGE
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State | CA
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Zip | 92868-4215
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Country | US
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Telephone | 714-509-4490
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Fax |
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Provider Business Mailing Address
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Address Line | 4100 LONG BEACH BLVD STE 108
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City | LONG BEACH
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State | CA
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Zip | 90807-2696
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Country | US
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Telephone | 562-426-3925
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Fax | 562-595-7639
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | A120510
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 207WX0110X
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Taxonomy Name | Pediatric Ophthalmology and Strabismus Specialist Physician Physician
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License Number | A120510
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License Number State | CA
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