Provider Demographics
NPI:1871517763
Name:BHASIN, SHARDA (MD)
Entity type:Individual
Prefix:DR
First Name:SHARDA
Middle Name:
Last Name:BHASIN
Suffix:
Gender:F
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:PO BOX 3129
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90510-3129
Mailing Address - Country:US
Mailing Address - Phone:310-792-3914
Mailing Address - Fax:855-898-4055
Practice Address - Street 1:3440 LOMITA BLVD
Practice Address - Street 2:STE 240
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90505-4871
Practice Address - Country:US
Practice Address - Phone:310-539-5060
Practice Address - Fax:310-539-7899
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2016-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA35177207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A351770Medicaid
CA954857156OtherTAX ID
CAE98630Medicare UPIN
CA00A351770Medicaid