Provider Demographics
NPI:1205091154
Name:GANGJI, HUSSEIN S (OD)
Entity type:Individual
Prefix:DR
First Name:HUSSEIN
Middle Name:S
Last Name:GANGJI
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17620 W LUNDBERG ST
Mailing Address - Street 2:
Mailing Address - City:SURPRISE
Mailing Address - State:AZ
Mailing Address - Zip Code:85388-3134
Mailing Address - Country:US
Mailing Address - Phone:773-502-7264
Mailing Address - Fax:
Practice Address - Street 1:12900 W THUNDERBIRD RD
Practice Address - Street 2:
Practice Address - City:EL MIRAGE
Practice Address - State:AZ
Practice Address - Zip Code:85335-5945
Practice Address - Country:US
Practice Address - Phone:623-583-8920
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-21
Last Update Date:2008-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1500152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist