Organization Name: | KHEMARA FAMILY MEDICAL CLINIC INC. |
NPI Number: | 1508296146 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | NAGASAMUDRA S. ASHOK (SOLE PROPRIETOR) |
Mailing Address: | 440 Redondo Ave Ste 201 Long Beach |
State: | CA US |
Postal Code: | 908145145 |
Phone Number: | 5624393803 |
Fax Number: | 8665937781 |
NPI Enumeration Date: | 11/18/2013 |
NPI Last Update Date: | 12/17/2013 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 208D00000X |
License Number: | A41589 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | CA |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | General Practice |
Taxonomy Specialization: | |
Taxonomy Definition: |