MEDICARE: DR. VIMAL J PONNEZHAN 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	207R00000X	Internal Medicine Physician	4301087977	MI
2	207RP1001X	Pulmonary Disease Physician	A116214	CA

General Provider Information

NPI Number	:	1366653354
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. VIMAL J PONNEZHAN MD

Provider Business Mailing Address
First Line	:	3579 E FOOTHILL BLVD STE 432
Second Line	:
City	:	PASADENA
State	:	CA
Zip	:	91107-3119
Country	:	US
Telephone Number	:	310-422-3000
Fax Number	:

Provider Business Practice Location Address
First Line	:	4081 E OLYMPIC BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90023-3330
Country	:	US
Telephone Number	:	323-267-0477
Fax Number	:

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

Provider Enumeration Date	:	05/24/2007
Last Update Date	:	08/24/2022

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