Provider Demographics
NPI:1144537218
Name:JARDOSH, HEMALI BHAKTA (OD)
Entity type:Individual
Prefix:DR
First Name:HEMALI
Middle Name:BHAKTA
Last Name:JARDOSH
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:HEMALI
Other - Middle Name:
Other - Last Name:BHAKTA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:8016 PRIVET LN
Mailing Address - Street 2:
Mailing Address - City:DOWNEY
Mailing Address - State:CA
Mailing Address - Zip Code:90241-6011
Mailing Address - Country:US
Mailing Address - Phone:562-208-3332
Mailing Address - Fax:
Practice Address - Street 1:340 LAKEWOOD CENTER MALL
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90712-2409
Practice Address - Country:US
Practice Address - Phone:562-602-6100
Practice Address - Fax:562-295-1520
Is Sole Proprietor?:No
Enumeration Date:2010-09-09
Last Update Date:2022-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDTA2328152W00000X
VA0618002186152W00000X
WI21424-875152W00000X
CA14065152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist