Provider Demographics
NPI:1417078882
Name:MANDAL, ALOKE KUMAR (MD, PHD)
Entity Type:Individual
Prefix:
First Name:ALOKE
Middle Name:KUMAR
Last Name:MANDAL
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3110 W LAKE CENTER DR
Mailing Address - Street 2:CA152-0243
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92704-6917
Mailing Address - Country:US
Mailing Address - Phone:714-335-6624
Mailing Address - Fax:
Practice Address - Street 1:3110 W LAKE CENTER DR
Practice Address - Street 2:CA152-0243
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92704-6917
Practice Address - Country:US
Practice Address - Phone:714-335-6624
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-03
Last Update Date:2016-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG87237204F00000X, 208600000X, 2086X0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204F00000XAllopathic & Osteopathic PhysiciansTransplant Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery
No2086X0206XAllopathic & Osteopathic PhysiciansSurgerySurgical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
G48477Medicare UPIN