Provider Demographics
NPI:1790231397
Name:PREMAL SANGHAVI MD INC
Entity Type:Organization
Organization Name:PREMAL SANGHAVI MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PERMAL
Authorized Official - Middle Name:
Authorized Official - Last Name:SANGHAVI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:714-522-2001
Mailing Address - Street 1:1513 S. GRAND AVE
Mailing Address - Street 2:SUITE 400
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90015-3021
Mailing Address - Country:US
Mailing Address - Phone:213-742-5784
Mailing Address - Fax:213-742-6405
Practice Address - Street 1:1513 S. GRAND AVE
Practice Address - Street 2:SUITE 400
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90015-3021
Practice Address - Country:US
Practice Address - Phone:213-742-5784
Practice Address - Fax:213-742-6405
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-01
Last Update Date:2016-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA90378208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty