Ida Ghlichloo, MD

Primary specialty

Student in an Organized Health Care Education/Training ProgramTaxonomy code 390200000X

Practice address

9500 Gilman Dr
La Jolla, CA 92093-1653

Phone

(650) 271-9445

NPI assigned

Feb 28, 2018

Reactivated

Oct 20, 2022

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Medicine

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

{
    "created_epoch": "1519776000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1667088000000",
    "number": "1124529797",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "472 BISCAYNE AVE",
            "city": "FOSTER CITY",
            "state": "CA",
            "postal_code": "944043550",
            "telephone_number": "650-288-8041"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9500 GILMAN DR",
            "city": "LA JOLLA",
            "state": "CA",
            "postal_code": "920931653",
            "telephone_number": "650-271-9445"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "424 Peninsula Ave",
            "address_purpose": "LOCATION",
            "city": "San Mateo",
            "state": "CA",
            "postal_code": "944011653",
            "country_code": "US",
            "telephone_number": "650-286-4396",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GHLICHLOO",
        "first_name": "IDA",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-02-28",
        "last_updated": "2022-10-30",
        "certification_date": "2022-10-30",
        "deactivation_date": "2022-04-11",
        "reactivation_date": "2022-10-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106E00000X",
            "taxonomy_group": "",
            "desc": "Assistant Behavior Analyst",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Bahman Ghannadian, MD, PHD
• Christine Emilie Ghatan, MD
• Omar A. Ghausi, M.D.
• Selemawit Teklia Ghebrendrias
• Seena Ghetmiri, DDS
• Pradipta Ghosh, M.D.
• Gianni Giancaspro
• Anna Delfina Giannella, R. D. - C. D. E.
• Ngoc-Minh Giap, RPH
• Paul Gibbs, MD

• Student in an Organized Health Care Education/Training Program in La Jolla, CA
• Providers in La Jolla, CA by specialty
• Student in an Organized Health Care Education/Training Program in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 30, 2022; 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.