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General NPI Number Information
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NPI Number | 1811559347
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Entity Type | Organization
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Legal Business Name | SHANTANU THAKUR, P.C.
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Dates
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Enumeration Date | 07/04/2019
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Last Update Date | 07/29/2024
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Provider Practice Location Address
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Address Line | 13039 VICTORY BLVD
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City | NORTH HOLLYWOOD
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State | CA
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Zip | 91606-2925
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Country | US
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Telephone | 213-283-9202
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Fax | 213-260-2306
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Provider Business Mailing Address
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Address Line | 440 N BARRANCA AVE STE 9202
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City | COVINA
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State | CA
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Zip | 91723-1722
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Country | US
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Telephone | 213-283-9202
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Fax | 213-260-2306
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Authorized Official
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Title or Position | CEO
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Name | SHANTANU KUMAR THAKUR
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Credential | MD
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Telephone | 213-283-9202
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number |
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License Number State |
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