Organization
KHEMARA FAMILY MEDICAL CLINIC INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. NAGASAMUDRA S. ASHOK M.D. (SOLE PROPRIETOR)
(562) 439-3803
Entity
Organization
Contact information
Practice address
440 REDONDO AVE STE 201, LONG BEACH, CA 90814-5145
(562) 439-3803
(866) 593-7781
Mailing address
440 REDONDO AVE STE 201, LONG BEACH, CA 90814-5145
(562) 439-3803
(866) 593-7781
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
A41589
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
10940873
CAQA PROVIDER ENROLLMENT
CA
01
—
A41589
MEDICAL LICENSE
CA
01
—
ZZZ58486Y
BLUE SHIELD PROVIDER #
CA
Enumeration date
11/18/2013
Last updated
12/17/2013
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