Provider Demographics
NPI:1063532315
Name:GANDHI, ASHOKKUMAR RATILAL (D,D,S,)
Entity type:Individual
Prefix:DR
First Name:ASHOKKUMAR
Middle Name:RATILAL
Last Name:GANDHI
Suffix:
Gender:M
Credentials:D,D,S,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5942 LANKERSHIM BLVD
Mailing Address - Street 2:
Mailing Address - City:NORTH HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:91601-1007
Mailing Address - Country:US
Mailing Address - Phone:818-985-7479
Mailing Address - Fax:818-985-7477
Practice Address - Street 1:5942 LANKERSHIM BLVD
Practice Address - Street 2:
Practice Address - City:NORTH HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:91601-1007
Practice Address - Country:US
Practice Address - Phone:818-985-7479
Practice Address - Fax:818-985-7477
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA36364122300000X
FL11495122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAB36364-01Medicaid