Provider Demographics
NPI:1023554128
Name:SHRIKANT TAMHANE, DO
Entity Type:Organization
Organization Name:SHRIKANT TAMHANE, DO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SUNANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:BHATIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-865-0263
Mailing Address - Street 1:23517 MAIN ST
Mailing Address - Street 2:SUITE 103
Mailing Address - City:CARSON
Mailing Address - State:CA
Mailing Address - Zip Code:90745-5251
Mailing Address - Country:US
Mailing Address - Phone:714-865-0263
Mailing Address - Fax:714-660-6106
Practice Address - Street 1:23517 MAIN ST
Practice Address - Street 2:SUITE 103
Practice Address - City:CARSON
Practice Address - State:CA
Practice Address - Zip Code:90745-5251
Practice Address - Country:US
Practice Address - Phone:714-865-0263
Practice Address - Fax:714-660-6106
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-12
Last Update Date:2017-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1497840748Medicare PIN