Provider Demographics
NPI:1265496111
Name:KOMALA IYENGAR M.D.INC
Entity Type:Organization
Organization Name:KOMALA IYENGAR M.D.INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ANESTHESIOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:KOMALA
Authorized Official - Middle Name:
Authorized Official - Last Name:IYENGAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD,
Authorized Official - Phone:310-916-7066
Mailing Address - Street 1:7301 EL DOMINO WAY
Mailing Address - Street 2:#3
Mailing Address - City:BUENA PARK
Mailing Address - State:CA
Mailing Address - Zip Code:90620-2652
Mailing Address - Country:US
Mailing Address - Phone:310-916-7066
Mailing Address - Fax:
Practice Address - Street 1:7301 EL DOMINO WAY
Practice Address - Street 2:#3
Practice Address - City:BUENA PARK
Practice Address - State:CA
Practice Address - Zip Code:90620-2652
Practice Address - Country:US
Practice Address - Phone:310-916-7066
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA032976282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA26994Medicare UPIN