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Organization
SANJAI THANKACHEN PA
Active
Organization
SANJAI THANKACHEN PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SANJAI MATHEW THANKACHEN MD (OWNER)
(714) 782-4700
Entity
Organization
Contact information
Practice address
19900 BEACH BLVD STE H, HUNTINGTON BEACH, CA 92648-3762
(877) 538-4133
Mailing address
4681 OCEANKNOLL DR, HUNTINGTON BEACH, CA 92649-6441
(714) 782-4700
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
A103818
STATE LICENSE
CA
Enumeration date
06/19/2017
Last updated
06/19/2017
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