Provider Demographics
NPI:1134340037
Name:GANJI, SHIVA KUMAR (MD)
Entity type:Individual
Prefix:DR
First Name:SHIVA
Middle Name:KUMAR
Last Name:GANJI
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 1:100 WILSON RD STE 100
Mailing Address - Street 2:
Mailing Address - City:MONTEREY
Mailing Address - State:CA
Mailing Address - Zip Code:93940-7885
Mailing Address - Country:US
Mailing Address - Phone:831-649-1000
Mailing Address - Fax:
Practice Address - Street 1:450 E ROMIE LN
Practice Address - Street 2:
Practice Address - City:SALINAS
Practice Address - State:CA
Practice Address - Zip Code:93901-4029
Practice Address - Country:US
Practice Address - Phone:831-757-4333
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-01
Last Update Date:2023-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0069499207R00000X
CAC147047208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDS062-0366OtherBLUE CROSS/BLUE SHIELD - REGIONAL
MD417948000Medicaid
MD954070-01 & 02OtherBLUE CROSS/BLUE SHIELD
MDS062-0366OtherBLUE CROSS/BLUE SHIELD - REGIONAL
MDP00814598Medicare PIN