Provider Demographics
NPI:1699823609
Name:GHELANI, JIGAR POPATLAL (MD)
Entity Type:Individual
Prefix:
First Name:JIGAR
Middle Name:POPATLAL
Last Name:GHELANI
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 1:227 W JANSS RD
Mailing Address - Street 2:SUITE 110
Mailing Address - City:THOUSAND OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91360-1848
Mailing Address - Country:US
Mailing Address - Phone:805-496-6051
Mailing Address - Fax:805-496-6785
Practice Address - Street 1:227 W JANSS RD
Practice Address - Street 2:SUITE 110
Practice Address - City:THOUSAND OAKS
Practice Address - State:CA
Practice Address - Zip Code:91360-1848
Practice Address - Country:US
Practice Address - Phone:805-496-6051
Practice Address - Fax:805-496-6785
Is Sole Proprietor?:No
Enumeration Date:2007-01-08
Last Update Date:2015-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA93280207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A932800Medicaid
CAWA93280BMedicare PIN