Provider Demographics
NPI:1598854978
Name:KALANTAR, NADER (MD)
Entity Type:Individual
Prefix:
First Name:NADER
Middle Name:
Last Name:KALANTAR
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 1:1334 W COVINA BLVD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:SAN DIMAS
Mailing Address - State:CA
Mailing Address - Zip Code:91773-3211
Mailing Address - Country:US
Mailing Address - Phone:909-592-2078
Mailing Address - Fax:909-592-0279
Practice Address - Street 1:1334 W COVINA BLVD
Practice Address - Street 2:SUITE 201
Practice Address - City:SAN DIMAS
Practice Address - State:CA
Practice Address - Zip Code:91773-3211
Practice Address - Country:US
Practice Address - Phone:909-592-2078
Practice Address - Fax:909-592-0279
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2016-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLTRN10472207Y00000X
CAA115578207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology