Provider Demographics
NPI:1538268560
Name:ARUN K MITTAL MD A MEDICAL CORPORATION
Entity type:Organization
Organization Name:ARUN K MITTAL MD A MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ARUN
Authorized Official - Middle Name:K
Authorized Official - Last Name:MITTAL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-792-5428
Mailing Address - Street 1:868 VIA DEL MONTE
Mailing Address - Street 2:
Mailing Address - City:PALOS VERDES ESTATES
Mailing Address - State:CA
Mailing Address - Zip Code:90274-1664
Mailing Address - Country:US
Mailing Address - Phone:310-792-5428
Mailing Address - Fax:310-792-5358
Practice Address - Street 1:4305 TORRANCE BLVD
Practice Address - Street 2:SUITE 305
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90503-4409
Practice Address - Country:US
Practice Address - Phone:310-792-5428
Practice Address - Fax:310-792-5358
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-22
Last Update Date:2013-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA24691208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)Group - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A246910Medicaid
A24077Medicare UPIN
CAA24691Medicare ID - Type Unspecified