Healthcare Provider Details

I. General information

NPI: 1992169825
Provider Name (Legal Business Name): AMBIKA BHUSHAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/06/2016
Last Update Date: 08/18/2026
Certification Date: 08/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 JOURNEY STE 240
ALISO VIEJO CA
92656-5332
US

IV. Provider business mailing address

5 JOURNEY STE 240
ALISO VIEJO CA
92656-5332
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA160265
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: