Provider Demographics
NPI:1174309546
Name:LANI CITY PRIMARY CARE
Entity type:Organization
Organization Name:LANI CITY PRIMARY CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:SUNIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:KHEMLANI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:909-727-3911
Mailing Address - Street 1:14071 PEYTON DR UNIT 2456
Mailing Address - Street 2:
Mailing Address - City:CHINO HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91709-7209
Mailing Address - Country:US
Mailing Address - Phone:909-727-3911
Mailing Address - Fax:
Practice Address - Street 1:150 W BASE LINE RD STE B
Practice Address - Street 2:
Practice Address - City:RIALTO
Practice Address - State:CA
Practice Address - Zip Code:92376-3358
Practice Address - Country:US
Practice Address - Phone:909-727-3911
Practice Address - Fax:909-727-3925
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LANI CITY MEDICAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-09-01
Last Update Date:2023-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty