Provider Demographics
NPI:1972824753
Name:GANDHI, ANIL KRISHNAKUMAR (MD)
Entity Type:Individual
Prefix:
First Name:ANIL
Middle Name:KRISHNAKUMAR
Last Name:GANDHI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:ANIL
Other - Middle Name:K
Other - Last Name:GANDI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:12231 ARTESIA BLVD.
Mailing Address - Street 2:
Mailing Address - City:CERRITOS
Mailing Address - State:CA
Mailing Address - Zip Code:90703-8143
Mailing Address - Country:US
Mailing Address - Phone:562-653-0180
Mailing Address - Fax:562-402-3029
Practice Address - Street 1:12231 ARTESIA BLVD.
Practice Address - Street 2:
Practice Address - City:CERRITOS
Practice Address - State:CA
Practice Address - Zip Code:90703-8143
Practice Address - Country:US
Practice Address - Phone:562-653-0180
Practice Address - Fax:562-402-3029
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-16
Last Update Date:2018-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA30411208D00000X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice