Organization
KANAN MODI MD INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KANAN MODI MD (OWNER)
(909) 394-9004
Entity
Organization
Contact information
Practice address
1305 W ARROW HWY STE 104, SAN DIMAS, CA 91773-2337
(909) 394-9004
(909) 394-9461
Mailing address
1305 W ARROW HWY STE 104, SAN DIMAS, CA 91773-2337
(909) 394-9004
(909) 394-9461
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
—
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1881704898
—
CA
Enumeration date
08/27/2013
Last updated
08/27/2013
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