Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | A77959 | CA |
N | 111NI0900X | Internist | A77959 | CA |
N | 207RA0201X | Internist - Allergy & Immunology | A77959 | CA |
N | 208000000X | Pediatrician | A77959 | CA |
NPI | 1285647487 |
---|---|
Provider Name | Rita Kachru |
First Address | Los Angeles, CA 90045-5631 |
Second Address | Santa Monica, CA 90404-1235 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/08/2006 |
Last Update Date | 02/01/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
A77959 | LICENSE (01) | CA |
H28275 | (02) | CA |
ZZZ73295Z | BLUE SHIELD (01) | CA |