Provider Demographics
NPI:1326347113
Name:ILLANGASEKARE, TUSHANI DIMANTHA (MD)
Entity Type:Individual
Prefix:DR
First Name:TUSHANI
Middle Name:DIMANTHA
Last Name:ILLANGASEKARE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:251 PARNASSUS AVE APT 1
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94117-3801
Mailing Address - Country:US
Mailing Address - Phone:530-848-4598
Mailing Address - Fax:
Practice Address - Street 1:1001 POTRERO AVE # 6D
Practice Address - Street 2:SFGH OB GYN
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94110-3518
Practice Address - Country:US
Practice Address - Phone:415-206-4069
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-03-20
Last Update Date:2018-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA123931207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CARES000Medicare UPIN