Provider Demographics
NPI:1881761179
Name:UDANI, MAHENDRA C (MD)
Entity type:Individual
Prefix:DR
First Name:MAHENDRA
Middle Name:C
Last Name:UDANI
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 1:520 N PROSPECT AVE
Mailing Address - Street 2:#102
Mailing Address - City:REDONDO BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90277-3041
Mailing Address - Country:US
Mailing Address - Phone:310-798-2006
Mailing Address - Fax:310-379-6199
Practice Address - Street 1:520 N PROSPECT AVE
Practice Address - Street 2:#102
Practice Address - City:REDONDO BEACH
Practice Address - State:CA
Practice Address - Zip Code:90277-3041
Practice Address - Country:US
Practice Address - Phone:310-798-2006
Practice Address - Fax:310-379-6199
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA35682174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist