Provider Demographics
NPI:1023150182
Name:KAMINI MALHOTRA, M.D INC
Entity type:Organization
Organization Name:KAMINI MALHOTRA, M.D INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KAMINI
Authorized Official - Middle Name:
Authorized Official - Last Name:MALHOTRA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:714-433-1330
Mailing Address - Street 1:17150 NEWHOPE ST
Mailing Address - Street 2:SUITE 117
Mailing Address - City:FOUNTAIN VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92708-4273
Mailing Address - Country:US
Mailing Address - Phone:714-433-1330
Mailing Address - Fax:714-755-2984
Practice Address - Street 1:17150 NEWHOPE ST
Practice Address - Street 2:SUITE 117
Practice Address - City:FOUNTAIN VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92708-4273
Practice Address - Country:US
Practice Address - Phone:714-433-1330
Practice Address - Fax:714-755-2984
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:KAMINI MALHOTRA, M.D INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-02-13
Last Update Date:2013-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical PathologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA05D0974660OtherPTAN
CAGR0083600Medicaid
CALAB7466OFMedicaid
CA05D0974660OtherPTAN