Healthcare Provider Details

I. General information

NPI: 1083981252
Provider Name (Legal Business Name): AKASHDEEP SINGH GILL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/16/2011
Last Update Date: 03/25/2025
Certification Date: 03/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11870 SANTA MONICA BLVD STE 106745
WEST LOS ANGELES CA
90025-2276
US

IV. Provider business mailing address

5294 THORNBURN ST
LOS ANGELES CA
90045-2258
US

V. Phone/Fax

Practice location:
  • Phone: 310-737-8499
  • Fax:
Mailing address:
  • Phone: 419-450-1832
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084A0401X
TaxonomyAddiction Medicine (Psychiatry & Neurology) Physician
License Number123279
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberX
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: