Provider Demographics
NPI:1750322566
Name:SARCOMA ONCOLOGY CENTER
Entity Type:Organization
Organization Name:SARCOMA ONCOLOGY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SANT
Authorized Official - Middle Name:P
Authorized Official - Last Name:CHAWLA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-552-9999
Mailing Address - Street 1:2811 WILSHIRE BLVD.
Mailing Address - Street 2:SUITE 414
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90403
Mailing Address - Country:US
Mailing Address - Phone:310-552-9999
Mailing Address - Fax:310-201-6685
Practice Address - Street 1:2811 WILSHIRE BLVD.
Practice Address - Street 2:SUITE 414
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90403
Practice Address - Country:US
Practice Address - Phone:310-552-9999
Practice Address - Fax:310-201-6685
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-10
Last Update Date:2010-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA45088207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAC14405Medicare UPIN
CAB82776Medicare UPIN