Basic Information
| Provider Information | |||||||||
| NPI: | 1316236565 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PATEL | ||||||||
| FirstName: | VIVEK-SAGAR | ||||||||
| MiddleName: | MUKESH | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 435 N ROXBURY DR STE 106 | ||||||||
| Address2: | |||||||||
| City: | BEVERLY HILLS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 902105003 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4243940959 | ||||||||
| FaxNumber: | 7133833727 | ||||||||
| Practice Location | |||||||||
| Address1: | 435 N ROXBURY DR STE 106 | ||||||||
| Address2: | |||||||||
| City: | BEVERLY HILLS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 902105003 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4243940959 | ||||||||
| FaxNumber: | 7133833727 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/28/2011 | ||||||||
| LastUpdateDate: | 08/30/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/30/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Y00000X | Q7945 | TX | N | Allopathic & Osteopathic Physicians | Otolaryngology | 207YS0123X | A156753 | CA | Y | Allopathic & Osteopathic Physicians | Otolaryngology | Facial Plastic Surgery |
No ID Information.