Healthcare Provider Details

I. General information

NPI: 1396003257
Provider Name (Legal Business Name): TISHANGI KUMAR AGRAWAL MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/30/2012
Last Update Date: 09/30/2024
Certification Date: 09/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1202 E GREEN ST
PASADENA CA
91106-3112
US

IV. Provider business mailing address

300 WHISPERING PINES DR
ARCADIA CA
91006-2400
US

V. Phone/Fax

Practice location:
  • Phone: 626-898-9858
  • Fax: 626-898-4749
Mailing address:
  • Phone: 626-898-9858
  • Fax: 626-898-4749

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberA139580
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License NumberA139580
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code207RA0001X
TaxonomyAdvanced Heart Failure and Transplant Cardiology Physician
License NumberA139580
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: