Provider Demographics
NPI:1518977685
Name:BHANDARKAR, SUNIL GOPAL (MD)
Entity Type:Individual
Prefix:
First Name:SUNIL
Middle Name:GOPAL
Last Name:BHANDARKAR
Suffix:
Gender:M
Credentials:MD
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Other - Credentials:
Mailing Address - Street 1:2200 COLORADO AVE
Mailing Address - Street 2:APT #516
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90404-3571
Mailing Address - Country:US
Mailing Address - Phone:310-828-0721
Mailing Address - Fax:
Practice Address - Street 1:321 N LARCHMONT BLVD
Practice Address - Street 2:SUITE #700
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90004-6407
Practice Address - Country:US
Practice Address - Phone:323-467-7161
Practice Address - Fax:323-467-3922
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2023-03-07
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAA91354207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA91354OtherSTATE LICENSE
CABB9403370OtherDEA NUMBER