Provider Demographics
NPI:1962726471
Name:MATHUR, ARVIND KISHORE (MD)
Entity type:Individual
Prefix:
First Name:ARVIND
Middle Name:KISHORE
Last Name:MATHUR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:861 BALSAM WAY
Mailing Address - Street 2:
Mailing Address - City:HEMET
Mailing Address - State:CA
Mailing Address - Zip Code:92545-8205
Mailing Address - Country:US
Mailing Address - Phone:909-206-8185
Mailing Address - Fax:
Practice Address - Street 1:1278 E LATHAM AVE
Practice Address - Street 2:
Practice Address - City:HEMET
Practice Address - State:CA
Practice Address - Zip Code:92543-4445
Practice Address - Country:US
Practice Address - Phone:951-925-6625
Practice Address - Fax:888-702-6846
Is Sole Proprietor?:No
Enumeration Date:2010-03-26
Last Update Date:2015-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA124774207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1962726471OtherPHYSICIAN