Provider Demographics
NPI:1407484603
Name:MEHTA, TEJ ISHAAN
Entity Type:Individual
Prefix:
First Name:TEJ
Middle Name:ISHAAN
Last Name:MEHTA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7840 S TOWNSLEY AVE UNIT 5
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57108-7604
Mailing Address - Country:US
Mailing Address - Phone:608-695-4215
Mailing Address - Fax:
Practice Address - Street 1:7840 S TOWNSLEY AVE UNIT 5
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57108-7604
Practice Address - Country:US
Practice Address - Phone:608-695-4215
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-01
Last Update Date:2020-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program