Provider Demographics
NPI:1053515825
Name:ARCHANA SHENDE M D INC
Entity type:Organization
Organization Name:ARCHANA SHENDE M D INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ARCHANA
Authorized Official - Middle Name:C
Authorized Official - Last Name:SHENDE
Authorized Official - Suffix:
Authorized Official - Credentials:M D
Authorized Official - Phone:714-999-1050
Mailing Address - Street 1:1211 W LA PALMA AVE
Mailing Address - Street 2:309
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92801-2815
Mailing Address - Country:US
Mailing Address - Phone:714-999-1050
Mailing Address - Fax:
Practice Address - Street 1:1211 W LA PALMA AVE
Practice Address - Street 2:309
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92801-2815
Practice Address - Country:US
Practice Address - Phone:714-999-1050
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-13
Last Update Date:2010-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA50235207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW15992Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER