Provider Demographics
NPI:1053689679
Name:ATUL K MADAN MD A MEDICAL CORPORATION
Entity Type:Organization
Organization Name:ATUL K MADAN MD A MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SURGEON
Authorized Official - Prefix:DR
Authorized Official - First Name:ATUL
Authorized Official - Middle Name:K
Authorized Official - Last Name:MADAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-869-7776
Mailing Address - Street 1:10573 W PICO BLVD # 859
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90064-2333
Mailing Address - Country:US
Mailing Address - Phone:310-869-7776
Mailing Address - Fax:866-933-0664
Practice Address - Street 1:3420 BRISTOL ST STE 700
Practice Address - Street 2:
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92626-7137
Practice Address - Country:US
Practice Address - Phone:213-973-2263
Practice Address - Fax:866-933-0664
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-09
Last Update Date:2015-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC53803208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty