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General NPI Number Information
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NPI Number | 1376617829
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Entity Type | Individual
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Provider Name | GAURAV K. GOSWAMI M.D.
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Gender | Male
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Dates
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Enumeration Date | 11/17/2006
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Last Update Date | 05/24/2023
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Provider Practice Location Address
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Address Line | 4425 JAMBOREE RD STE 120
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City | NEWPORT BEACH
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State | CA
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Zip | 92660-3044
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Country | US
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Telephone | 949-387-9991
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Fax | 949-387-9995
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Provider Business Mailing Address
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Address Line | 4425 JAMBOREE RD STE 120
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City | NEWPORT BEACH
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State | CA
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Zip | 92660-3044
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Country | US
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Telephone | 949-387-9991
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Fax | 949-387-9995
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0204X
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Taxonomy Name | Vascular & Interventional Radiology Physician
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License Number | A97150
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License Number State | CA
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