Healthcare Provider Details

I. General information

NPI: 1518453422
Provider Name (Legal Business Name): PRIYANKA VISHWANATH GOGTE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/03/2018
Last Update Date: 11/21/2025
Certification Date: 11/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3300 E SOUTH ST STE 308
LAKEWOOD CA
90805-4598
US

IV. Provider business mailing address

PO BOX 4249
WHITTIER CA
90607-4249
US

V. Phone/Fax

Practice location:
  • Phone: 562-630-3111
  • Fax: 562-630-3107
Mailing address:
  • Phone: 562-696-9265
  • Fax: 877-887-8750

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License NumberA174257
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA174257
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: