Provider Demographics
NPI:1255148490
Name:R. NANDAN, M.D., INC
Entity type:Organization
Organization Name:R. NANDAN, M.D., INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RAGHU
Authorized Official - Middle Name:
Authorized Official - Last Name:NANDAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:562-272-7630
Mailing Address - Street 1:3650 SOUTH ST STE 212
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90712-1528
Mailing Address - Country:US
Mailing Address - Phone:562-272-7630
Mailing Address - Fax:562-272-7631
Practice Address - Street 1:3650 SOUTH ST STE 212
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90712-1528
Practice Address - Country:US
Practice Address - Phone:562-272-7630
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-12-11
Last Update Date:2024-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332900000XSuppliersNon-Pharmacy Dispensing Site