Provider Demographics
NPI:1427196492
Name:NAIKMAGANLAL, PREMALKUMAR
Entity Type:Individual
Prefix:DR
First Name:PREMALKUMAR
Middle Name:
Last Name:NAIKMAGANLAL
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 1:24941 SUNNYMEAD BLVD
Mailing Address - Street 2:
Mailing Address - City:MORENO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92553-3701
Mailing Address - Country:US
Mailing Address - Phone:909-859-4095
Mailing Address - Fax:951-924-8200
Practice Address - Street 1:24941 SUNNYMEAD BLVD
Practice Address - Street 2:
Practice Address - City:MORENO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92553-3701
Practice Address - Country:US
Practice Address - Phone:909-859-4095
Practice Address - Fax:951-824-2700
Is Sole Proprietor?:No
Enumeration Date:2007-02-02
Last Update Date:2013-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA55038122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAD55038Medicaid