Provider Demographics
NPI:1083807531
Name:BANGA, ALOK (MD,MBBS,MPH, MS)
Entity Type:Individual
Prefix:DR
First Name:ALOK
Middle Name:
Last Name:BANGA
Suffix:
Gender:M
Credentials:MD,MBBS,MPH, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9370 W STOCKTON BLVD STE 130
Mailing Address - Street 2:
Mailing Address - City:ELK GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:95758-8013
Mailing Address - Country:US
Mailing Address - Phone:916-647-4044
Mailing Address - Fax:916-647-4290
Practice Address - Street 1:9303 LAGUNA SPRINGS DR STE 110
Practice Address - Street 2:
Practice Address - City:ELK GROVE
Practice Address - State:CA
Practice Address - Zip Code:95758-7834
Practice Address - Country:US
Practice Address - Phone:916-647-4044
Practice Address - Fax:916-647-4290
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-18
Last Update Date:2023-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA1313102084P0800X, 2084P0804X, 2084P0804X
CT0475492084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent PsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT1083807531Medicaid