Healthcare Provider Details

I. General information

NPI: 1477580298
Provider Name (Legal Business Name): GNANA DESIGAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6850 SEPULVEDA BLVD SUITE 214
VAN NUYS CA
91405
US

IV. Provider business mailing address

6850 SEPULVEDA BLVD SUITE 214
VAN NUYS CA
91405
US

V. Phone/Fax

Practice location:
  • Phone: 818-782-3116
  • Fax: 818-782-3148
Mailing address:
  • Phone: 818-782-3116
  • Fax: 818-782-3148

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberC41859
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: