Provider Demographics
NPI:1659391134
Name:GANESAN, USHA V (MD)
Entity Type:Individual
Prefix:DR
First Name:USHA
Middle Name:V
Last Name:GANESAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:17541 IRVINE BLVD STE E
Mailing Address - Street 2:
Mailing Address - City:TUSTIN
Mailing Address - State:CA
Mailing Address - Zip Code:92780-3158
Mailing Address - Country:US
Mailing Address - Phone:949-229-5964
Mailing Address - Fax:949-567-8647
Practice Address - Street 1:17541 IRVINE BLVD STE E
Practice Address - Street 2:
Practice Address - City:TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92780-3158
Practice Address - Country:US
Practice Address - Phone:949-229-5964
Practice Address - Fax:949-567-8647
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-20
Last Update Date:2024-03-11
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAA73506208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CABK7187746OtherDEA
CABK7187746OtherDEA