Provider Demographics
NPI:1255357315
Name:MOTI S DASWANI MD INC
Entity type:Organization
Organization Name:MOTI S DASWANI MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MOTI
Authorized Official - Middle Name:S
Authorized Official - Last Name:DASWANI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:562-630-7279
Mailing Address - Street 1:3300 E SOUTH ST
Mailing Address - Street 2:110
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90805
Mailing Address - Country:US
Mailing Address - Phone:562-630-7279
Mailing Address - Fax:562-630-8828
Practice Address - Street 1:3300 E SOUTH ST
Practice Address - Street 2:110
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90805
Practice Address - Country:US
Practice Address - Phone:562-630-7279
Practice Address - Fax:562-630-8828
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-14
Last Update Date:2008-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0060560Medicaid
CAGR0060560Medicaid