Provider Demographics
NPI:1659554103
Name:SATISH K. LAL MD A PROFESSINAL CORPORATION
Entity Type:Organization
Organization Name:SATISH K. LAL MD A PROFESSINAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SATISH
Authorized Official - Middle Name:KUMAR
Authorized Official - Last Name:LAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-949-6534
Mailing Address - Street 1:10841 WHITE OAK AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91730-3811
Mailing Address - Country:US
Mailing Address - Phone:909-989-4002
Mailing Address - Fax:909-989-4004
Practice Address - Street 1:10841 WHITE OAK AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91730-3811
Practice Address - Country:US
Practice Address - Phone:909-989-4002
Practice Address - Fax:909-989-4004
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-06
Last Update Date:2016-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
A34462174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
008257250OtherMEDICARE
JR0101740OtherMEDICAL
330024674OtherCORPORATE
F22330Medicare UPIN
JR0101740OtherMEDICAL