Provider Demographics
NPI:1740036045
Name:USHA GANESAN MD INC
Entity type:Organization
Organization Name:USHA GANESAN MD INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:USHA
Authorized Official - Middle Name:
Authorized Official - Last Name:GANESAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:949-229-5964
Mailing Address - Street 1:17541 IRVINE BLVD STE E
Mailing Address - Street 2:
Mailing Address - City:TUSTIN
Mailing Address - State:CA
Mailing Address - Zip Code:92780-3158
Mailing Address - Country:US
Mailing Address - Phone:949-229-5964
Mailing Address - Fax:949-567-8647
Practice Address - Street 1:17541 IRVINE BLVD STE E
Practice Address - Street 2:
Practice Address - City:TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92780-3158
Practice Address - Country:US
Practice Address - Phone:949-229-5964
Practice Address - Fax:949-567-8647
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-26
Last Update Date:2024-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty