Provider Demographics
NPI:1851497499
Name:AVINASH M MONDAR MD A MEDICAL CORP
Entity Type:Organization
Organization Name:AVINASH M MONDAR MD A MEDICAL CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:AVINASH
Authorized Official - Middle Name:M
Authorized Official - Last Name:MONDKAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-657-1995
Mailing Address - Street 1:8641 WILSHIRE BLVD STE 220
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90211-2920
Mailing Address - Country:US
Mailing Address - Phone:310-657-1995
Mailing Address - Fax:
Practice Address - Street 1:8641 WILSHIRE BLVD STE 220
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90211-2920
Practice Address - Country:US
Practice Address - Phone:310-657-1995
Practice Address - Fax:310-657-5311
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-14
Last Update Date:2015-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA35142207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW236Medicare PIN
CA00A351421Medicare PIN
CAA27691Medicare UPIN
CA00A351420Medicare PIN
CAZZZ04627ZMedicare PIN
CAWA35142BMedicare PIN