Provider Demographics
NPI:1548415854
Name:GANJI, HOMAYOON JOHN (MD)
Entity Type:Individual
Prefix:MR
First Name:HOMAYOON
Middle Name:JOHN
Last Name:GANJI
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 1:31662 ISLE VISTA
Mailing Address - Street 2:
Mailing Address - City:LAGUNA NIGUEL
Mailing Address - State:CA
Mailing Address - Zip Code:92677
Mailing Address - Country:US
Mailing Address - Phone:949-280-3120
Mailing Address - Fax:
Practice Address - Street 1:31662 ISLE VISTA
Practice Address - Street 2:
Practice Address - City:LAGUNA NIGUEL
Practice Address - State:CA
Practice Address - Zip Code:92677-5444
Practice Address - Country:US
Practice Address - Phone:949-280-3120
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-01
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA20795208D00000X
WAMD00012616208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA20795OtherJOHN H. GANJL, MD LIC #
BG7924512OtherDEA #
WAA07665Medicare UPIN