Provider Demographics
NPI:1255423976
Name:GASTRO-DIGESTIVE MEDICAL GROUP
Entity type:Organization
Organization Name:GASTRO-DIGESTIVE MEDICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:MR
Authorized Official - First Name:SUSHIL
Authorized Official - Middle Name:K
Authorized Official - Last Name:OJHA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-346-6525
Mailing Address - Street 1:11480 BROOKSHIRE AVENUE
Mailing Address - Street 2:#308
Mailing Address - City:DOWNEY
Mailing Address - State:CA
Mailing Address - Zip Code:90241-5020
Mailing Address - Country:US
Mailing Address - Phone:562-862-3656
Mailing Address - Fax:562-862-2948
Practice Address - Street 1:11480 BROOKSHIRE AVENUE
Practice Address - Street 2:#308
Practice Address - City:DOWNEY
Practice Address - State:CA
Practice Address - Zip Code:90241-5020
Practice Address - Country:US
Practice Address - Phone:562-862-3656
Practice Address - Fax:562-862-2948
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Not Answered207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0094710Medicaid
CAW16332Medicare ID - Type Unspecified