Provider Demographics
NPI:1730120700
Name:PRAKASH, AMITABH (MD)
Entity Type:Individual
Prefix:DR
First Name:AMITABH
Middle Name:
Last Name:PRAKASH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7510 E SANTIAGO CANYON RD
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92869-1804
Mailing Address - Country:US
Mailing Address - Phone:714-639-1740
Mailing Address - Fax:
Practice Address - Street 1:9080 COLIMA RD
Practice Address - Street 2:
Practice Address - City:WHITTIER
Practice Address - State:CA
Practice Address - Zip Code:90605-1600
Practice Address - Country:US
Practice Address - Phone:562-907-1565
Practice Address - Fax:562-907-1585
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2008-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA37785207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A377850Medicaid
CA00A377850Medicaid
CAWA37785GMedicare PIN
CAWA37785DMedicare PIN