Provider Demographics
NPI:1013068162
Name:AVINASH M. MONDKAR M.D.,A MEDICAL CORPORATION
Entity Type:Organization
Organization Name:AVINASH M. MONDKAR M.D.,A MEDICAL CORPORATION
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
Mailing Address - Street 2:#220
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90211-2900
Mailing Address - Country:US
Mailing Address - Phone:310-657-1995
Mailing Address - Fax:310-657-5311
Practice Address - Street 1:1041 N CHINA LAKE BLVD
Practice Address - Street 2:SUITE A
Practice Address - City:RIDGECREST
Practice Address - State:CA
Practice Address - Zip Code:93555-3168
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:2007-01-16
Last Update Date:2009-09-10
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
CA00A351420Medicaid
P00736288OtherPALMETTO GBA MEDICARE/NORTHERN CA
756063687OtherPALMETTO GBA MEDICARE/SOUTHERN CA
P00736288OtherPALMETTO GBA MEDICARE/NORTHERN CA
CA00A351420Medicaid