Provider Demographics
NPI:1427002427
Name:DANDEKAR, NANDKUMAR (MD)
Entity Type:Individual
Prefix:DR
First Name:NANDKUMAR
Middle Name:
Last Name:DANDEKAR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:NANDKUMAR
Other - Middle Name:
Other - Last Name:DANDEKAR
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:26816 VISTA TER
Mailing Address - Street 2:
Mailing Address - City:LAKE FOREST
Mailing Address - State:CA
Mailing Address - Zip Code:92630-8115
Mailing Address - Country:US
Mailing Address - Phone:949-588-2190
Mailing Address - Fax:949-588-2199
Practice Address - Street 1:315 N 3RD AVE
Practice Address - Street 2:STE 307
Practice Address - City:COVINA
Practice Address - State:CA
Practice Address - Zip Code:91723-1905
Practice Address - Country:US
Practice Address - Phone:626-915-6406
Practice Address - Fax:626-967-7725
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-22
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA25061208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A250610Medicaid
CAA25061Medicare ID - Type UnspecifiedMEDICARE NUMBER
CA00A250610Medicaid