Provider Demographics
NPI:1871655480
Name:TAMBOLI, KAUSHAL R (MD)
Entity Type:Individual
Prefix:DR
First Name:KAUSHAL
Middle Name:R
Last Name:TAMBOLI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:8317 DAVIS ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:DOWNEY
Mailing Address - State:CA
Mailing Address - Zip Code:90241-4918
Mailing Address - Country:US
Mailing Address - Phone:562-869-1511
Mailing Address - Fax:562-869-0771
Practice Address - Street 1:8317 DAVIS ST
Practice Address - Street 2:SUITE A
Practice Address - City:DOWNEY
Practice Address - State:CA
Practice Address - Zip Code:90241-4918
Practice Address - Country:US
Practice Address - Phone:562-869-1511
Practice Address - Fax:562-869-0771
Is Sole Proprietor?:No
Enumeration Date:2006-12-14
Last Update Date:2014-10-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA38408207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA060068098OtherMEDICARE RAILROAD
CA00A384080Medicaid
CA00A384080Medicaid
CAWA38408HMedicare PIN
CA060068098OtherMEDICARE RAILROAD