Provider Demographics
NPI:1164526224
Name:DAS, MALAY R (MD)
Entity Type:Individual
Prefix:
First Name:MALAY
Middle Name:R
Last Name:DAS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:4477 W 118TH STREET
Mailing Address - Street 2:SUITE 409
Mailing Address - City:HAWTHORNE
Mailing Address - State:CA
Mailing Address - Zip Code:90250
Mailing Address - Country:US
Mailing Address - Phone:310-219-0647
Mailing Address - Fax:310-219-4066
Practice Address - Street 1:4477 W 118TH STREET
Practice Address - Street 2:SUITE 409
Practice Address - City:HAWTHORNE
Practice Address - State:CA
Practice Address - Zip Code:90250
Practice Address - Country:US
Practice Address - Phone:310-219-0647
Practice Address - Fax:310-219-4066
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-11
Last Update Date:2010-07-25
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAA34000207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A340000Medicaid
CAA84555Medicare UPIN
CAA34000AMedicare ID - Type Unspecified