Provider Demographics
NPI:1003833948
Name:BAKHRU, JYOTI MANOHAR (MD)
Entity type:Individual
Prefix:DR
First Name:JYOTI
Middle Name:MANOHAR
Last Name:BAKHRU
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:JYOTI
Other - Middle Name:BHAG
Other - Last Name:VACHANI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:4281 KATELLA AVE
Mailing Address - Street 2:220
Mailing Address - City:LOS ALAMITOS
Mailing Address - State:CA
Mailing Address - Zip Code:90720-3500
Mailing Address - Country:US
Mailing Address - Phone:714-768-6501
Mailing Address - Fax:
Practice Address - Street 1:4281 KATELLA AVE STE 220
Practice Address - Street 2:
Practice Address - City:LOS ALAMITOS
Practice Address - State:CA
Practice Address - Zip Code:90720-6506
Practice Address - Country:US
Practice Address - Phone:714-252-1135
Practice Address - Fax:714-226-0681
Is Sole Proprietor?:No
Enumeration Date:2006-07-16
Last Update Date:2013-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA44963207RA0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RA0000XAllopathic & Osteopathic PhysiciansInternal MedicineAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAE98040Medicare UPIN