Provider Demographics
NPI:1467482216
Name:BANDARI, DANIEL S (MD)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:S
Last Name:BANDARI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3900 W COAST HWY
Mailing Address - Street 2:SUITE 330
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92663-4091
Mailing Address - Country:US
Mailing Address - Phone:949-706-5580
Mailing Address - Fax:949-706-5585
Practice Address - Street 1:3900 W COAST HWY
Practice Address - Street 2:SUITE 330
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92663-4091
Practice Address - Country:US
Practice Address - Phone:949-706-5580
Practice Address - Fax:949-706-5585
Is Sole Proprietor?:No
Enumeration Date:2006-07-04
Last Update Date:2011-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA843502084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A843500Medicaid
CAWA84350AMedicare ID - Type UnspecifiedMEDICARE INDIVIDUAL #
CA00A843500Medicaid