MEDICARE: DR. KAUSHAL RAMESH PATEL MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208600000X	Surgery Physician	A79162	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	00A791620	OTHER	CA	MEDICAL PPIN #

General Provider Information

NPI Number	:	1023032133
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KAUSHAL RAMESH PATEL MD

Provider Business Mailing Address
First Line	:	4760 W SUNSET BLVD
Second Line	:	3RD FLOOR
City	:	LOS ANGELES
State	:	CA
Zip	:	90027-6063
Country	:	US
Telephone Number	:	323-783-4903
Fax Number	:	323-783-8747

Provider Business Practice Location Address
First Line	:	1510 SAN PABLO ST
Second Line	:	SUITE 514
City	:	LOS ANGELES
State	:	CA
Zip	:	90033-5320
Country	:	US
Telephone Number	:	323-442-5988
Fax Number	:	323-442-5735

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/26/2006
Last Update Date	:	12/08/2021

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