Provider Demographics
NPI:1841793619
Name:DARMAHKASIH, ANDREW JEREMY (MD)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:JEREMY
Last Name:DARMAHKASIH
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 1:800 FAIRMOUNT AVE STE 310
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91105-3153
Mailing Address - Country:US
Mailing Address - Phone:626-449-7350
Mailing Address - Fax:626-449-1321
Practice Address - Street 1:800 FAIRMOUNT AVE STE 310
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91105-3153
Practice Address - Country:US
Practice Address - Phone:626-449-7350
Practice Address - Fax:626-449-1321
Is Sole Proprietor?:No
Enumeration Date:2018-03-17
Last Update Date:2021-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA164751208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics