Healthcare Provider Details

I. General information

NPI: 1881198885
Provider Name (Legal Business Name): AKAANSHA GANJU MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2018
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10921 WILSHIRE BLVD STE 604
LOS ANGELES CA
90024-4003
US

IV. Provider business mailing address

4215 TULLER AVE
CULVER CITY CA
90230-4711
US

V. Phone/Fax

Practice location:
  • Phone: 310-606-1006
  • Fax:
Mailing address:
  • Phone: 617-913-7127
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License NumberA173640
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: