Provider Demographics
NPI:1639196579
Name:R. NANDAN, M.D., INC
Entity Type:Organization
Organization Name:R. NANDAN, M.D., INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RAGHU
Authorized Official - Middle Name:
Authorized Official - Last Name:NANDAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:562-272-7630
Mailing Address - Street 1:3650 SOUTH ST
Mailing Address - Street 2:212
Mailing Address - City:LAKEWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90712-1502
Mailing Address - Country:US
Mailing Address - Phone:562-272-7630
Mailing Address - Fax:562-272-7631
Practice Address - Street 1:3650 SOUTH ST
Practice Address - Street 2:212
Practice Address - City:LAKEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90712-1502
Practice Address - Country:US
Practice Address - Phone:562-272-7630
Practice Address - Fax:562-272-7631
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-16
Last Update Date:2020-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA51197207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW14124Medicare PIN
CA6692760001Medicare NSC