Provider Demographics
NPI:1073999181
Name:KRUNAL J MEHTA MD INC
Entity Type:Organization
Organization Name:KRUNAL J MEHTA MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KRUNAL
Authorized Official - Middle Name:
Authorized Official - Last Name:MEHTA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:626-656-0256
Mailing Address - Street 1:130 W ROUTE 66 STE 214
Mailing Address - Street 2:
Mailing Address - City:GLENDORA
Mailing Address - State:CA
Mailing Address - Zip Code:91740-6251
Mailing Address - Country:US
Mailing Address - Phone:626-335-4129
Mailing Address - Fax:626-335-6177
Practice Address - Street 1:130 W ROUTE 66 STE 214
Practice Address - Street 2:
Practice Address - City:GLENDORA
Practice Address - State:CA
Practice Address - Zip Code:91740-6251
Practice Address - Country:US
Practice Address - Phone:626-335-4129
Practice Address - Fax:626-335-6177
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-31
Last Update Date:2015-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADI524AMedicare PIN