Organization
S M KHANDHAR DO A PROFESSIONAL MEDICAL CORPORATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SUMIT M KHANDHAR DO (MEDICAL DIRECTOR)
(650) 954-5542
Entity
Organization
Contact information
Practice address
1820 FULLERTON AVE STE 125, CORONA, CA 92881-3160
(650) 954-5542
Mailing address
1820 FULLERTON AVE STE 125, CORONA, CA 92881-3160
(650) 954-5542
Taxonomy
Speciality
Code
Description
License number
State
207RI0011X
Interventional Cardiology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
20A10557
STATE LICENSE
CA
Enumeration date
10/30/2019
Last updated
10/30/2019
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