Provider Demographics
NPI:1023032133
Name:PATEL, KAUSHAL RAMESH (MD)
Entity type:Individual
Prefix:DR
First Name:KAUSHAL
Middle Name:RAMESH
Last Name:PATEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4760 W SUNSET BLVD
Mailing Address - Street 2:3RD FLOOR
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90027-6063
Mailing Address - Country:US
Mailing Address - Phone:323-783-4903
Mailing Address - Fax:323-783-8747
Practice Address - Street 1:1510 SAN PABLO ST
Practice Address - Street 2:SUITE 514
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90033-5320
Practice Address - Country:US
Practice Address - Phone:323-442-5988
Practice Address - Fax:323-442-5735
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2021-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA79162208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A791620OtherMEDICAL PPIN #
CAWA79162AMedicare ID - Type UnspecifiedPPIN #
CA00A791620OtherMEDICAL PPIN #