Provider Demographics
NPI:1952570301
Name:GANGSEI, DAVID LYLE (PHD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:LYLE
Last Name:GANGSEI
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 151240
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92175
Mailing Address - Country:US
Mailing Address - Phone:619-278-2403
Mailing Address - Fax:619-294-9405
Practice Address - Street 1:3990 OLD TOWN AVE
Practice Address - Street 2:SUITE C 201
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92110
Practice Address - Country:US
Practice Address - Phone:619-278-2403
Practice Address - Fax:619-294-9405
Is Sole Proprietor?:No
Enumeration Date:2008-02-29
Last Update Date:2008-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PSY6363103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist