Provider Demographics
NPI:1952655656
Name:M R DAS MD INC A MEDICAL CORPORATION
Entity Type:Organization
Organization Name:M R DAS MD INC A MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD, PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MALAY
Authorized Official - Middle Name:R
Authorized Official - Last Name:DAS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-219-0647
Mailing Address - Street 1:4477 W 118TH ST
Mailing Address - Street 2:STE 409
Mailing Address - City:HAWTHORNE
Mailing Address - State:CA
Mailing Address - Zip Code:90250-2255
Mailing Address - Country:US
Mailing Address - Phone:310-219-0647
Mailing Address - Fax:310-219-4066
Practice Address - Street 1:4477 W 118TH ST
Practice Address - Street 2:STE 409
Practice Address - City:HAWTHORNE
Practice Address - State:CA
Practice Address - Zip Code:90250-2255
Practice Address - Country:US
Practice Address - Phone:310-219-0647
Practice Address - Fax:310-219-4066
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-01
Last Update Date:2023-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA34000207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty