Provider Demographics
NPI:1932383841
Name:RAMESH K. MANCHANDA, M.D. MEDICAL CORPORATION
Entity type:Organization
Organization Name:RAMESH K. MANCHANDA, M.D. MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RAMESH
Authorized Official - Middle Name:KUMAR
Authorized Official - Last Name:MANCHANDA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:323-307-0810
Mailing Address - Street 1:PO BOX 80624
Mailing Address - Street 2:
Mailing Address - City:SAN MARINO
Mailing Address - State:CA
Mailing Address - Zip Code:91118-8624
Mailing Address - Country:US
Mailing Address - Phone:323-307-0810
Mailing Address - Fax:323-307-0813
Practice Address - Street 1:1700 E CESAR E CHAVEZ AVE
Practice Address - Street 2:#3800
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90033-2424
Practice Address - Country:US
Practice Address - Phone:323-307-0810
Practice Address - Fax:323-307-0813
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-27
Last Update Date:2008-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA26288282N00000X, 261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0002930Medicaid
CAW6490Medicare PIN