Integrative Diagnostic Group Inc

Primary specialty

Adult Medicine PhysicianTaxonomy code 207QA0505X

License

A30411 Issued in CA

Legal business name

INTEGRATIVE DIAGNOSTIC GROUP INC

Practice address

12231 Artesia Blvd
Cerritos, CA 90703-2750

Phone

(562) 653-0180

Fax

(562) 402-3029

NPI assigned

Sep 1, 2016

Organization subpart

Yes

Parent organization

INTEGRATIVE DIAGNOSTIC GROUP INCAs reported in NPPES

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

Authorized official

Name

Mr. Anil K Ganghi, MD.

Title

President

Phone

(562) 653-0180

Specialties & licenses 2

Addresses

Other identifiers 1

Other names 1

• INTEGRATIVE DIAGNOSTIC GROUP INC Other name

Part of

Integrative Diagnostic Group Inc

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Anil Krishnakumar Gandhi, M.D.

  • Surgery Physician
  • Cerritos, CA
  • NPI 1972824753
  NPD (past)

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

{
    "created_epoch": "1472688000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1472688000000",
    "number": "1104373745",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1231 ARTESIA BLVD",
            "city": "CERRITOS",
            "state": "CA",
            "postal_code": "907032750",
            "telephone_number": "562-653-0180",
            "fax_number": "562-402-3029"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12231 ARTESIA BLVD",
            "city": "CERRITOS",
            "state": "CA",
            "postal_code": "907032750",
            "telephone_number": "562-653-0180",
            "fax_number": "562-402-3029"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INTEGRATIVE DIAGNOSTIC GROUP INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "INTEGRATIVE DIAGNOSTIC GROUP INC",
        "enumeration_date": "2016-09-01",
        "last_updated": "2016-09-01",
        "status": "A",
        "authorized_official_last_name": "GANGHI",
        "authorized_official_first_name": "ANIL",
        "authorized_official_middle_name": "K",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "562-653-0180",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "MD."
    },
    "taxonomies": [
        {
            "code": "207QA0505X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Family Medicine, Adult Medicine",
            "state": "CA",
            "license": "A30411",
            "primary": true
        },
        {
            "code": "323P00000X",
            "taxonomy_group": "",
            "desc": "Psychiatric Residential Treatment Facility",
            "state": "CA",
            "license": "PSY6247",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1972824753",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "INTEGRATIVE DIAGNOSTIC GROUP INC",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

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• Adult Medicine Physician in Cerritos, CA
• Providers in Cerritos, CA by specialty
• Adult Medicine Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 1, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.