Healthcare Provider Details

I. General information

NPI: 1144553538
Provider Name (Legal Business Name): VYJAYANTHI GANGA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/16/2009
Last Update Date: 05/18/2026
Certification Date: 05/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13401 N WESTERN AVE STE 302
OKLAHOMA CITY OK
73114-1411
US

IV. Provider business mailing address

13401 N WESTERN AVE STE 302
OKLAHOMA CITY OK
73114-1411
US

V. Phone/Fax

Practice location:
  • Phone: 405-272-6685
  • Fax: 405-272-6690
Mailing address:
  • Phone: 405-272-6685
  • Fax: 405-272-6690

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number37928
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberE-8075
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: