Healthcare Provider Details

I. General information

NPI: 1679438766
Provider Name (Legal Business Name): INTELLISURGE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/19/2025
Last Update Date: 12/19/2025
Certification Date: 12/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10212 WESTMINSTER AVE STE 102
GARDEN GROVE CA
92843-4800
US

IV. Provider business mailing address

10212 WESTMINSTER AVE STE 102
GARDEN GROVE CA
92843-4800
US

V. Phone/Fax

Practice location:
  • Phone: 714-530-8900
  • Fax: 714-509-0605
Mailing address:
  • Phone: 714-530-8900
  • Fax: 714-509-0605

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207YP0228X
TaxonomyPediatric Otolaryngology Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: SIVARAMAN K GOUNDER
Title or Position: OWNER/MANAGING MEMBER
Credential: MD
Phone: 908-361-0185