Provider Demographics
NPI:1992878672
Name:DAS, BIRENDRA NATH (MD)
Entity type:Individual
Prefix:MR
First Name:BIRENDRA
Middle Name:NATH
Last Name:DAS
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 1:44215 15TH ST. W.
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:CA
Mailing Address - Zip Code:93534
Mailing Address - Country:US
Mailing Address - Phone:661-949-5990
Mailing Address - Fax:661-949-5233
Practice Address - Street 1:44241 N 15TH ST WEST
Practice Address - Street 2:#102
Practice Address - City:LANCASTER
Practice Address - State:CA
Practice Address - Zip Code:93534-4068
Practice Address - Country:US
Practice Address - Phone:661-949-5990
Practice Address - Fax:661-949-5233
Is Sole Proprietor?:No
Enumeration Date:2006-11-17
Last Update Date:2017-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA32522208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A32522Medicaid