Healthcare Provider Details

I. General information

NPI: 1184948119
Provider Name (Legal Business Name): GAGANDEEP SINGH RAHI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/19/2010
Last Update Date: 04/15/2020
Certification Date: 04/15/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4955 VAN NUYS BLVD STE 502
SHERMAN OAKS CA
91403-1817
US

IV. Provider business mailing address

1100 E WILLOW ST
SIGNAL HILL CA
90755-3433
US

V. Phone/Fax

Practice location:
  • Phone: 818-325-0200
  • Fax: 818-325-0210
Mailing address:
  • Phone: 562-981-7896
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA111097
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number263444
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberA111097
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: