Provider Demographics
NPI:1326029398
Name:WHANG, GILBERT (MD)
Entity Type:Individual
Prefix:
First Name:GILBERT
Middle Name:
Last Name:WHANG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9998 CROSSPOINT BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46256-3307
Mailing Address - Country:US
Mailing Address - Phone:317-579-2150
Mailing Address - Fax:317-579-2130
Practice Address - Street 1:1325 BELHAVEN RD
Practice Address - Street 2:
Practice Address - City:SAN MARINO
Practice Address - State:CA
Practice Address - Zip Code:91108-2708
Practice Address - Country:US
Practice Address - Phone:317-806-8285
Practice Address - Fax:317-489-6750
Is Sole Proprietor?:No
Enumeration Date:2005-11-08
Last Update Date:2021-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA946272085B0100X, 2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Yes2085B0100XAllopathic & Osteopathic PhysiciansRadiologyBody Imaging
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A946270G56OtherBLUE SHIELD
CA00A909360Medicaid
CAP00394832OtherRAIL ROAD MEDICARE
CAWA94627AMedicare PIN
CAWA94627DMedicare PIN
CAWA94627CMedicare PIN
CAP00394832OtherRAIL ROAD MEDICARE
CA00A946270G56OtherBLUE SHIELD