Healthcare Provider Details

I. General information

NPI: 1780977066
Provider Name (Legal Business Name): GIRIRAJ K. SHARMA MD, MS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/19/2011
Last Update Date: 09/26/2023
Certification Date: 04/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

360 SAN MIGUEL DR STE 409
NEWPORT BEACH CA
92660-7822
US

IV. Provider business mailing address

360 SAN MIGUEL DR STE 409
NEWPORT BEACH CA
92660-7822
US

V. Phone/Fax

Practice location:
  • Phone: 949-688-7334
  • Fax:
Mailing address:
  • Phone: 949-688-7334
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License NumberA127561
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number0101274538
License Number StateVA
# 3
Primary TaxonomyN
Taxonomy Code207YS0123X
TaxonomyFacial Plastic Surgery Physician
License Number0101274538
License Number StateVA
# 4
Primary TaxonomyY
Taxonomy Code207YS0123X
TaxonomyFacial Plastic Surgery Physician
License NumberA127561
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: