Provider Demographics
NPI:1659459824
Name:HETHUMUNI, GAMINI D (MD)
Entity Type:Individual
Prefix:
First Name:GAMINI
Middle Name:D
Last Name:HETHUMUNI
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 1:1527 GLEN OAKS BLVD
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91105
Mailing Address - Country:US
Mailing Address - Phone:626-683-8301
Mailing Address - Fax:
Practice Address - Street 1:416 W LAS TUNAS DR
Practice Address - Street 2:STE 300
Practice Address - City:SAN GABRIEL
Practice Address - State:CA
Practice Address - Zip Code:91776
Practice Address - Country:US
Practice Address - Phone:626-281-1851
Practice Address - Fax:626-281-9062
Is Sole Proprietor?:No
Enumeration Date:2006-11-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA33433207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A334330Medicaid
CAA33433Medicare ID - Type Unspecified
A27150Medicare UPIN