Provider Demographics
NPI:1811559347
Name:SHANTANU THAKUR, P.C.
Entity Type:Organization
Organization Name:SHANTANU THAKUR, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:SHANTANU
Authorized Official - Middle Name:KUMAR
Authorized Official - Last Name:THAKUR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:213-283-9202
Mailing Address - Street 1:440 N BARRANCA AVE STE 9202
Mailing Address - Street 2:
Mailing Address - City:COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91723-1722
Mailing Address - Country:US
Mailing Address - Phone:213-283-9202
Mailing Address - Fax:213-260-2306
Practice Address - Street 1:6442 COLDWATER CANYON AVE STE 117
Practice Address - Street 2:
Practice Address - City:NORTH HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:91606-1184
Practice Address - Country:US
Practice Address - Phone:213-283-9202
Practice Address - Fax:213-260-2306
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-04
Last Update Date:2023-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty