Provider Demographics
NPI:1538470562
Name:GAJJAR, ASHISH (MD)
Entity Type:Individual
Prefix:
First Name:ASHISH
Middle Name:
Last Name:GAJJAR
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 1:1819 POLK ST
Mailing Address - Street 2:#370
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94109
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2420 SONOMA STREET
Practice Address - Street 2:STE B
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96001-3033
Practice Address - Country:US
Practice Address - Phone:530-999-2533
Practice Address - Fax:530-999-2532
Is Sole Proprietor?:No
Enumeration Date:2010-06-24
Last Update Date:2024-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA1455772084N0400X, 2084V0102X
GA0721872084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084V0102XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyVascular Neurology
No2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA145577OtherCA LICENSE