Provider Demographics
NPI:1801812300
Name:SANGHA, AJMEL S (MD)
Entity type:Individual
Prefix:DR
First Name:AJMEL
Middle Name:S
Last Name:SANGHA
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 1:5111 GARFIELD ST STE B
Mailing Address - Street 2:
Mailing Address - City:LA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:91941-5103
Mailing Address - Country:US
Mailing Address - Phone:619-698-9375
Mailing Address - Fax:619-698-9378
Practice Address - Street 1:5111 GARFIELD ST STE B
Practice Address - Street 2:
Practice Address - City:LA MESA
Practice Address - State:CA
Practice Address - Zip Code:91941-5103
Practice Address - Country:US
Practice Address - Phone:619-698-9375
Practice Address - Fax:619-698-9378
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA049344207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA49344AMedicare ID - Type Unspecified
CAE89590Medicare UPIN