Provider Demographics
NPI:1982608568
Name:GHEEWALA, UMESH HANSRAJ (MD)
Entity Type:Individual
Prefix:DR
First Name:UMESH
Middle Name:HANSRAJ
Last Name:GHEEWALA
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 1:325 DISTEL CIR
Mailing Address - Street 2:
Mailing Address - City:LOS ALTOS
Mailing Address - State:CA
Mailing Address - Zip Code:94022-1408
Mailing Address - Country:US
Mailing Address - Phone:650-696-4758
Mailing Address - Fax:
Practice Address - Street 1:100 S SAN MATEO DR
Practice Address - Street 2:
Practice Address - City:SAN MATEO
Practice Address - State:CA
Practice Address - Zip Code:94401-3805
Practice Address - Country:US
Practice Address - Phone:650-696-4758
Practice Address - Fax:650-404-8408
Is Sole Proprietor?:No
Enumeration Date:2005-06-10
Last Update Date:2023-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMD-3715207R00000X
CAA38329207RG0300X, 208000000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA38329OtherCA STATE MEDICAL LICENSE
HIMD-03715OtherHAWAII STATE MED LICENSE
HIMD-03715OtherHAWAII STATE MED LICENSE
CA00A383291Medicare PIN
BG0454126OtherFEDERAL DEA #