Healthcare Provider Details

I. General information

NPI: 1164642583
Provider Name (Legal Business Name): RISHI GARG M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/26/2007
Last Update Date: 10/04/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

289 W HUNTINGTON DR STE 103
ARCADIA CA
91007-3492
US

IV. Provider business mailing address

PO BOX 90730
PASADENA CA
91109-0730
US

V. Phone/Fax

Practice location:
  • Phone: 626-821-0707
  • Fax: 626-821-0239
Mailing address:
  • Phone: 626-821-0707
  • Fax: 626-821-0239

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberA90302
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License NumberA90302
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: