Provider Demographics
NPI:1598860645
Name:KEDIA, MRIDULA (MD)
Entity Type:Individual
Prefix:DR
First Name:MRIDULA
Middle Name:
Last Name:KEDIA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1746 GATES AVE
Mailing Address - Street 2:
Mailing Address - City:MANHATTAN BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90266-7031
Mailing Address - Country:US
Mailing Address - Phone:310-798-8145
Mailing Address - Fax:
Practice Address - Street 1:4201 TORRANCE BLVD STE 740
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90503-4521
Practice Address - Country:US
Practice Address - Phone:310-540-5676
Practice Address - Fax:310-543-3092
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA43406208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG30007Medicare UPIN
A43406Medicare ID - Type Unspecified