Provider Demographics
NPI:1497868251
Name:TAMHANE, SHRIKANT (DO)
Entity Type:Individual
Prefix:DR
First Name:SHRIKANT
Middle Name:
Last Name:TAMHANE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 N. GALE DRIVE UNIT 404
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90211
Mailing Address - Country:US
Mailing Address - Phone:310-779-0515
Mailing Address - Fax:310-834-5619
Practice Address - Street 1:23517 MAIN ST STE 103
Practice Address - Street 2:
Practice Address - City:CARSON
Practice Address - State:CA
Practice Address - Zip Code:90745-5234
Practice Address - Country:US
Practice Address - Phone:310-834-5388
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-16
Last Update Date:2017-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A7213207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00AX72130Medicaid
CA20A72130Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER
CA00AX72130Medicaid