Provider Demographics
NPI:1588620363
Name:MADAN, ATUL (MD)
Entity Type:Individual
Prefix:DR
First Name:ATUL
Middle Name:
Last Name:MADAN
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 1:10573 W PICO BLVD # 859
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90064-2333
Mailing Address - Country:US
Mailing Address - Phone:310-869-7776
Mailing Address - Fax:866-933-0664
Practice Address - Street 1:23838 VALENCIA BLVD
Practice Address - Street 2:
Practice Address - City:VALENCIA
Practice Address - State:CA
Practice Address - Zip Code:91355-5319
Practice Address - Country:US
Practice Address - Phone:213-973-2263
Practice Address - Fax:424-248-0985
Is Sole Proprietor?:No
Enumeration Date:2006-04-21
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC53803208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3876107Medicaid
TN3876107Medicare ID - Type UnspecifiedTN MEDICARE
H65060Medicare UPIN