Provider Demographics
NPI:1578614657
Name:MAKANDURA, LAKSHMAN D (MD)
Entity Type:Individual
Prefix:DR
First Name:LAKSHMAN
Middle Name:D
Last Name:MAKANDURA
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 1:910 S SUNSET AVE
Mailing Address - Street 2:SUITE # 8
Mailing Address - City:WEST COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91790-3409
Mailing Address - Country:US
Mailing Address - Phone:626-338-8407
Mailing Address - Fax:626-338-3937
Practice Address - Street 1:910 S SUNSET AVE
Practice Address - Street 2:SUITE # 8
Practice Address - City:WEST COVINA
Practice Address - State:CA
Practice Address - Zip Code:91790-3409
Practice Address - Country:US
Practice Address - Phone:626-338-8407
Practice Address - Fax:626-338-3937
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA049715207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A497153OtherMEDI CAL
CAF32536Medicare UPIN
CAA49715AMedicare ID - Type Unspecified