Healthcare Provider Details

I. General information

NPI: 1568133908
Provider Name (Legal Business Name): AMBIKA BHUSHAN MD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/24/2021
Last Update Date: 08/13/2026
Certification Date: 08/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 JOURNEY STE 240
ALISO VIEJO CA
92656-5332
US

IV. Provider business mailing address

PO BOX 2339
BEVERLY HILLS CA
90213-2339
US

V. Phone/Fax

Practice location:
  • Phone: 949-382-2050
  • Fax: 949-382-2051
Mailing address:
  • Phone: 949-415-4874
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number
License Number State

VIII. Authorized Official

Name: AMBIKA BHUSHAN
Title or Position: MD / OWNER
Credential:
Phone: 203-676-8357