Provider Demographics
NPI:1699829762
Name:DEVGAN, BALDEV KRISHAN (MD)
Entity Type:Individual
Prefix:DR
First Name:BALDEV
Middle Name:KRISHAN
Last Name:DEVGAN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:11735 W WASHINGTON BLVD
Mailing Address - Street 2:SUITE # 101
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90066-5917
Mailing Address - Country:US
Mailing Address - Phone:310-390-9829
Mailing Address - Fax:310-391-1290
Practice Address - Street 1:11735 W WASHINGTON BLVD
Practice Address - Street 2:SUITE # 101
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90066-5917
Practice Address - Country:US
Practice Address - Phone:310-390-9829
Practice Address - Fax:310-391-1290
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-23
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAC38752207YX0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YX0007XAllopathic & Osteopathic PhysiciansOtolaryngologyPlastic Surgery within the Head & Neck