Provider Demographics
NPI:1598897159
Name:GOGINENI, USHAKUMAR (DO)
Entity Type:Individual
Prefix:DR
First Name:USHAKUMAR
Middle Name:
Last Name:GOGINENI
Suffix:
Gender:M
Credentials:DO
Other - Prefix:DR
Other - First Name:KUMAR
Other - Middle Name:
Other - Last Name:GOGINENI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DO
Mailing Address - Street 1:13220 ROSE ST
Mailing Address - Street 2:
Mailing Address - City:CERRITOS
Mailing Address - State:CA
Mailing Address - Zip Code:90703-8644
Mailing Address - Country:US
Mailing Address - Phone:562-900-4930
Mailing Address - Fax:714-220-5959
Practice Address - Street 1:13220 ROSE ST
Practice Address - Street 2:
Practice Address - City:CERRITOS
Practice Address - State:CA
Practice Address - Zip Code:90703-8644
Practice Address - Country:US
Practice Address - Phone:562-404-2882
Practice Address - Fax:562-404-2882
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-09
Last Update Date:2014-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A9287207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine