Provider Demographics
NPI:1538126131
Name:CHAURUSHIA, GAURANG BHAGWATPRASAD (MD)
Entity Type:Individual
Prefix:MR
First Name:GAURANG
Middle Name:BHAGWATPRASAD
Last Name:CHAURUSHIA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11480 BROOKSHIRE AVE
Mailing Address - Street 2:#308
Mailing Address - City:DOWNEY
Mailing Address - State:CA
Mailing Address - Zip Code:90241-5020
Mailing Address - Country:US
Mailing Address - Phone:562-862-3656
Mailing Address - Fax:562-862-2948
Practice Address - Street 1:11480 BROOKSHIRE AVE
Practice Address - Street 2:#308
Practice Address - City:DOWNEY
Practice Address - State:CA
Practice Address - Zip Code:90241-5020
Practice Address - Country:US
Practice Address - Phone:562-862-3656
Practice Address - Fax:562-862-2948
Is Sole Proprietor?:No
Enumeration Date:2006-04-27
Last Update Date:2011-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAA9360207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A493600Medicaid
WA49360DMedicare ID - Type Unspecified
CA00A493600Medicaid