Provider Demographics
NPI:1205827623
Name:LALL, ASHOK (MD)
Entity Type:Individual
Prefix:
First Name:ASHOK
Middle Name:
Last Name:LALL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25958 COLERIDGE PL
Mailing Address - Street 2:
Mailing Address - City:STEVENSON RANCH
Mailing Address - State:CA
Mailing Address - Zip Code:91381-1547
Mailing Address - Country:US
Mailing Address - Phone:702-419-6670
Mailing Address - Fax:
Practice Address - Street 1:27420 TOURNEY RD
Practice Address - Street 2:SUITE 200
Practice Address - City:VALENCIA
Practice Address - State:CA
Practice Address - Zip Code:91355
Practice Address - Country:US
Practice Address - Phone:702-419-6670
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-03
Last Update Date:2018-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV8382207R00000X
CAA64108207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVF40812Medicare UPIN