Provider Demographics
NPI:1760838536
Name:LAKHANPAL, SURYA KANTI (MD)
Entity Type:Individual
Prefix:DR
First Name:SURYA
Middle Name:KANTI
Last Name:LAKHANPAL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2333 FOOTHILL BLVD STE B
Mailing Address - Street 2:
Mailing Address - City:LA VERNE
Mailing Address - State:CA
Mailing Address - Zip Code:91750-3027
Mailing Address - Country:US
Mailing Address - Phone:909-392-6501
Mailing Address - Fax:909-469-2136
Practice Address - Street 1:2333 FOOTHILL BLVD STE B
Practice Address - Street 2:
Practice Address - City:LA VERNE
Practice Address - State:CA
Practice Address - Zip Code:91750-3027
Practice Address - Country:US
Practice Address - Phone:909-392-6501
Practice Address - Fax:909-469-2136
Is Sole Proprietor?:No
Enumeration Date:2016-05-10
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXS2624207Q00000X
CA168504207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1528703733Medicaid