Healthcare Provider Details

I. General information

NPI: 1871385476
Provider Name (Legal Business Name): EJIGU MEDICAL SERVICES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/20/2025
Last Update Date: 09/10/2025
Certification Date: 09/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3621 MARTIN LUTHER KING JR BLVD STE 6
LYNWOOD CA
90262-3512
US

IV. Provider business mailing address

3621 MARTIN LUTHER KING JR BLVD STE 6
LYNWOOD CA
90262-3512
US

V. Phone/Fax

Practice location:
  • Phone: 310-537-1503
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QP3300X
TaxonomyPain Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code282NC0060X
TaxonomyCritical Access Hospital
License Number
License Number State

VIII. Authorized Official

Name: TESHAGER GASHAW EJIGU
Title or Position: INTERNIST,PULMONOLOGIST,INTENSIVIST
Credential: MD
Phone: 571-239-7049