Provider Demographics
NPI:1457427197
Name:BHARDWAJ, ASHWANI (MD)
Entity Type:Individual
Prefix:
First Name:ASHWANI
Middle Name:
Last Name:BHARDWAJ
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:PO BOX 1434
Mailing Address - Street 2:
Mailing Address - City:AGOURA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91376-1434
Mailing Address - Country:US
Mailing Address - Phone:562-739-5532
Mailing Address - Fax:818-778-6322
Practice Address - Street 1:15211 VANOWEN ST 207
Practice Address - Street 2:
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91405-3621
Practice Address - Country:US
Practice Address - Phone:818-778-6332
Practice Address - Fax:818-778-6322
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-27
Last Update Date:2015-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA54408207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1457427197OtherNPI
CA00A544080Medicaid
A54408Medicare ID - Type Unspecified
G25234Medicare UPIN