Provider Demographics
NPI:1609810886
Name:DODHIAWALA, BHUPENDRA T (MD)
Entity Type:Individual
Prefix:DR
First Name:BHUPENDRA
Middle Name:T
Last Name:DODHIAWALA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:210 N TUSTIN AVE
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92705-3807
Mailing Address - Country:US
Mailing Address - Phone:714-347-1000
Mailing Address - Fax:714-647-1245
Practice Address - Street 1:1145 W REDONDO BEACH BLVD
Practice Address - Street 2:
Practice Address - City:GARDENA
Practice Address - State:CA
Practice Address - Zip Code:90247-3511
Practice Address - Country:US
Practice Address - Phone:310-532-4200
Practice Address - Fax:310-538-6680
Is Sole Proprietor?:No
Enumeration Date:2006-06-16
Last Update Date:2023-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY231569207L00000X
WAMD00046574207L00000X
CAA106406207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8481616Medicaid
NY02712903Medicaid
CACB223394Medicare PIN
WAG8866458Medicare PIN
NY02712903Medicaid
NYI46812Medicare UPIN