Provider Demographics
NPI:1912215351
Name:SADASHIVA NAIK, GAYATHRI (MD)
Entity Type:Individual
Prefix:
First Name:GAYATHRI
Middle Name:
Last Name:SADASHIVA NAIK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:510 SUPERIOR AVE
Mailing Address - Street 2:STE 200B
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92663-3663
Mailing Address - Country:US
Mailing Address - Phone:949-791-3001
Mailing Address - Fax:949-791-3096
Practice Address - Street 1:16300 SAND CANYON AVE
Practice Address - Street 2:STE 311
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92618-3711
Practice Address - Country:US
Practice Address - Phone:949-791-3101
Practice Address - Fax:949-791-3112
Is Sole Proprietor?:No
Enumeration Date:2010-09-20
Last Update Date:2023-01-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA123231207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGT669ZMedicare PIN