Provider Demographics
NPI:1316242639
Name:LAKSHMAN D MAKANDURA MD INC
Entity type:Organization
Organization Name:LAKSHMAN D MAKANDURA MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LAKSHMAN
Authorized Official - Middle Name:D
Authorized Official - Last Name:MAKANDURA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:626-338-8407
Mailing Address - Street 1:910 S SUNSET AVE
Mailing Address - Street 2:SUITE 8
Mailing Address - City:WEST COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91790-3409
Mailing Address - Country:US
Mailing Address - Phone:626-338-8407
Mailing Address - Fax:626-338-3937
Practice Address - Street 1:910 S SUNSET AVE
Practice Address - Street 2:SUITE 8
Practice Address - City:WEST COVINA
Practice Address - State:CA
Practice Address - Zip Code:91790-3409
Practice Address - Country:US
Practice Address - Phone:626-338-8407
Practice Address - Fax:626-338-3937
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-18
Last Update Date:2011-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA49715207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty