Provider Demographics
NPI:1235134263
Name:MALHOTRA, KAMINI (MD)
Entity Type:Individual
Prefix:
First Name:KAMINI
Middle Name:
Last Name:MALHOTRA
Suffix:
Gender:F
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:PO BOX 8969
Mailing Address - Street 2:
Mailing Address - City:FOUNTAIN VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92728-8969
Mailing Address - Country:US
Mailing Address - Phone:714-433-1330
Mailing Address - Fax:714-755-2984
Practice Address - Street 1:17150 NEWHOPE ST
Practice Address - Street 2:STE 117
Practice Address - City:FOUNTAIN VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92708-4273
Practice Address - Country:US
Practice Address - Phone:714-433-1330
Practice Address - Fax:714-755-2984
Is Sole Proprietor?:No
Enumeration Date:2005-06-16
Last Update Date:2007-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA32453207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0083600Medicaid
CAGR0083600Medicaid