Provider Demographics
NPI:1710110358
Name:BHATIA, MUKESH (MD)
Entity Type:Individual
Prefix:
First Name:MUKESH
Middle Name:
Last Name:BHATIA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6029 BRISTOL PKWY
Mailing Address - Street 2:SUITE 100
Mailing Address - City:CULVER CITY
Mailing Address - State:CA
Mailing Address - Zip Code:90230-6643
Mailing Address - Country:US
Mailing Address - Phone:310-417-5900
Mailing Address - Fax:310-410-1001
Practice Address - Street 1:6029 BRISTOL PKWY
Practice Address - Street 2:SUITE 100
Practice Address - City:CULVER CITY
Practice Address - State:CA
Practice Address - Zip Code:90230-6643
Practice Address - Country:US
Practice Address - Phone:310-417-5900
Practice Address - Fax:310-410-1001
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-31
Last Update Date:2009-08-31
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG45160207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA92555Medicare UPIN