Provider Demographics
NPI:1003839838
Name:AGARWAL, ASHOK KUMAR (MD, FACC)
Entity Type:Individual
Prefix:
First Name:ASHOK
Middle Name:KUMAR
Last Name:AGARWAL
Suffix:
Gender:M
Credentials:MD, FACC
Other - Prefix:DR
Other - First Name:ASHOK
Other - Middle Name:K
Other - Last Name:AGARWAL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:136 S. SAN JACINTO STREET
Mailing Address - Street 2:
Mailing Address - City:HEMET
Mailing Address - State:CA
Mailing Address - Zip Code:92543-3097
Mailing Address - Country:US
Mailing Address - Phone:951-652-8100
Mailing Address - Fax:951-658-5325
Practice Address - Street 1:136 S. SAN JACINTO STREET
Practice Address - Street 2:
Practice Address - City:HEMET
Practice Address - State:CA
Practice Address - Zip Code:92543-3097
Practice Address - Country:US
Practice Address - Phone:951-652-8100
Practice Address - Fax:951-658-5325
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-25
Last Update Date:2017-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA422040174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA330160450OtherTAX ID
CAA29527Medicare UPIN