Provider Demographics
NPI:1184701104
Name:BHALLA, ASHISH (MD)
Entity type:Individual
Prefix:
First Name:ASHISH
Middle Name:
Last Name:BHALLA
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1601 MONTE VISTA AVE
Mailing Address - Street 2:SUITE 190
Mailing Address - City:CLAREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:91711-2962
Mailing Address - Country:US
Mailing Address - Phone:909-865-9977
Mailing Address - Fax:909-946-0166
Practice Address - Street 1:3110 CHINO AVE
Practice Address - Street 2:SUITE 150B
Practice Address - City:CHINO HILLS
Practice Address - State:CA
Practice Address - Zip Code:91709-1211
Practice Address - Country:US
Practice Address - Phone:909-630-7868
Practice Address - Fax:909-630-7869
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2023-03-07
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Provider Licenses
StateLicense IDTaxonomies
CAA104992207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FB1082673OtherDEA