Provider Demographics
NPI:1437480571
Name:KAVITA SURTI MD INC
Entity Type:Organization
Organization Name:KAVITA SURTI MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:KAVITA
Authorized Official - Middle Name:
Authorized Official - Last Name:SURTI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:909-636-3630
Mailing Address - Street 1:475 W BADILLO ST
Mailing Address - Street 2:
Mailing Address - City:COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91723-1834
Mailing Address - Country:US
Mailing Address - Phone:626-732-2200
Mailing Address - Fax:626-732-2900
Practice Address - Street 1:475 W BADILLO ST
Practice Address - Street 2:
Practice Address - City:COVINA
Practice Address - State:CA
Practice Address - Zip Code:91723-1834
Practice Address - Country:US
Practice Address - Phone:626-732-2200
Practice Address - Fax:626-732-2900
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-28
Last Update Date:2010-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA6412610001Medicare NSC
CAA83552Medicare PIN