Provider Demographics
NPI:1982851143
Name:JOSHI, SUSHAN
Entity Type:Individual
Prefix:
First Name:SUSHAN
Middle Name:
Last Name:JOSHI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3400 LOMITA BLVD STE 104
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90505-4900
Mailing Address - Country:US
Mailing Address - Phone:310-784-8000
Mailing Address - Fax:310-784-8008
Practice Address - Street 1:3400 LOMITA BLVD STE 104
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90505-4900
Practice Address - Country:US
Practice Address - Phone:310-784-8000
Practice Address - Fax:310-784-8008
Is Sole Proprietor?:No
Enumeration Date:2008-08-19
Last Update Date:2024-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD154091207R00000X
CAC192634207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR930635514OtherNBMC MAIN GROUP TAX ID
OR1407812365OtherNBMC MAIN GROUP NPI
OR160423OtherMEDICARE-PTAN
R0000WFBTVOtherNBMC MAIN GROUP MEDICARE
OR500635717Medicaid
OR161133OtherNBMC MAIN GROUP MEDICAID