Healthcare Provider Details

I. General information

NPI: 1104938679
Provider Name (Legal Business Name): GHANSHYAM LOHIYA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 10/22/2008
Certification Date:
Deactivation Date: 08/25/2008
Reactivation Date: 10/01/2008

III. Provider practice location address

1120 W. WARNER A
SANTA ANA CA
92707
US

IV. Provider business mailing address

1120 W. WARNER AV A
SANTA ANA CA
92707
US

V. Phone/Fax

Practice location:
  • Phone: 714-444-4448
  • Fax: 714-444-9892
Mailing address:
  • Phone: 714-444-4448
  • Fax: 714-444-9892

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2083X0100X
TaxonomyOccupational Medicine Physician
License NumberA34243
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code2083P0500X
TaxonomyPreventive Medicine/Occupational Environmental Medicine Physician
License NumberA34243
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License NumberA34243
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA34243
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: