Healthcare Provider Details

I. General information

NPI: 1386214732
Provider Name (Legal Business Name): ORANGE COAST CARDIOLOGY MEDICAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/29/2021
Last Update Date: 01/19/2025
Certification Date: 01/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

520 SUPERIOR AVE STE 220
NEWPORT BEACH CA
92663-3671
US

IV. Provider business mailing address

28241 CROWN VALLEY PKWY # F337
LAGUNA NIGUEL CA
92677-4441
US

V. Phone/Fax

Practice location:
  • Phone: 949-515-4515
  • Fax: 949-515-4508
Mailing address:
  • Phone: 949-515-4515
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207UN0901X
TaxonomyNuclear Cardiology Physician
License Number
License Number State

VIII. Authorized Official

Name: RADHAKRISHAN S GANDHI
Title or Position: PRESIDENT
Credential: MD
Phone: 949-515-4515