Provider Demographics
NPI:1003829797
Name:LONG BEACH GASTROENTEROLOGY ASSOCIATES
Entity Type:Organization
Organization Name:LONG BEACH GASTROENTEROLOGY ASSOCIATES
Other - Org Name:LONG BEACH GASTROENTEROLOGY ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MD, PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:KALPANA
Authorized Official - Middle Name:
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:562-595-5421
Mailing Address - Street 1:3833 WORSHAM AVE
Mailing Address - Street 2:SUITE 300
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90808-1766
Mailing Address - Country:US
Mailing Address - Phone:562-595-5421
Mailing Address - Fax:562-426-2862
Practice Address - Street 1:3833 WORSHAM AVE
Practice Address - Street 2:SUITE 300
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90808-1766
Practice Address - Country:US
Practice Address - Phone:562-595-5421
Practice Address - Fax:562-426-2862
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-14
Last Update Date:2021-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Multi-Specialty
No174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW5009Medicaid
CAGR0058960Medicaid