Irving Lee Gislason, MD

Primary specialty

Clinical Neurophysiology PhysicianTaxonomy code 2084N0600X

License

A24010 Issued in CA

Practice address

12443 Lewis St. Ste. 103
Garden Grove, CA 92840-4650

Phone

(714) 971-7652

Fax

(714) 971-8927

NPI assigned

Apr 8, 2008

Last updated

May 12, 2021By the provider in NPPES

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Opted out of Medicare

Yes, effective Jun 7, 2018 through Jun 7, 2028

Medicare enrollment (NPD)

Not enrolled

HHS exclusion list flag

Flagged The directory lists this NPI on an HHS exclusion list. Confirm with the OIG exclusions search.

Credentials

Doctor of Medicine

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1207612800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1620777600000",
    "number": "1013180355",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7404 E. SADDLEHILL TRL",
            "city": "ORANGE",
            "state": "CA",
            "postal_code": "928692310",
            "telephone_number": "714-971-7652",
            "fax_number": "714-971-8927"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12443 LEWIS ST. STE. 103",
            "city": "GARDEN GROVE",
            "state": "CA",
            "postal_code": "928404650",
            "telephone_number": "714-971-7652",
            "fax_number": "714-971-8927"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GISLASON",
        "first_name": "IRVING",
        "middle_name": "LEE",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2008-04-08",
        "last_updated": "2021-05-12",
        "certification_date": "2021-05-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084N0600X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Clinical Neurophysiology",
            "state": "CA",
            "license": "A24010",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Clinical Neurophysiology Physician in Garden Grove, CA
• Providers in Garden Grove, CA by specialty
• Clinical Neurophysiology Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 12, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits; OIG LEIE.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.