Provider Demographics
NPI:1578854170
Name:MUKHTAIR SINGH KUNDI, M.D., INC., A MEDICAL CORPORATION
Entity type:Organization
Organization Name:MUKHTAIR SINGH KUNDI, M.D., INC., A MEDICAL CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MUKHTAIR
Authorized Official - Middle Name:SINGH
Authorized Official - Last Name:KUNDI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:626-960-1402
Mailing Address - Street 1:1740 W CAMERON AVE
Mailing Address - Street 2:SUITE 110
Mailing Address - City:WEST COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91790-2719
Mailing Address - Country:US
Mailing Address - Phone:626-960-1402
Mailing Address - Fax:626-337-7651
Practice Address - Street 1:1740 W CAMERON AVE
Practice Address - Street 2:SUITE 110
Practice Address - City:WEST COVINA
Practice Address - State:CA
Practice Address - Zip Code:91790-2719
Practice Address - Country:US
Practice Address - Phone:626-960-1402
Practice Address - Fax:626-337-7651
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-29
Last Update Date:2011-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA41283302F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A41283Medicaid
CA2762110OtherOTHER
CA2762110OtherOTHER
CAB50461Medicare UPIN