Provider Demographics
NPI:1417240714
Name:ANDREW D RAH, A CALIFORNIA MEDICAL CORP
Entity Type:Organization
Organization Name:ANDREW D RAH, A CALIFORNIA MEDICAL CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:D
Authorized Official - Last Name:RAH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-528-6115
Mailing Address - Street 1:1809 E DYER RD
Mailing Address - Street 2:SUITE 311
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92705-5740
Mailing Address - Country:US
Mailing Address - Phone:949-863-0022
Mailing Address - Fax:949-863-0023
Practice Address - Street 1:11411 BROOKSHIRE AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:DOWNEY
Practice Address - State:CA
Practice Address - Zip Code:90241-5026
Practice Address - Country:US
Practice Address - Phone:562-803-6116
Practice Address - Fax:562-803-6308
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-18
Last Update Date:2011-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG82333173000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes173000000XOther Service ProvidersLegal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAFB257AMedicare PIN