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General NPI Number Information
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NPI Number | 1679438766
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Entity Type | Organization
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Legal Business Name | INTELLISURGE LLC
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Dates
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Enumeration Date | 12/19/2025
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Last Update Date | 12/19/2025
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Provider Practice Location Address
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Address Line | 10212 WESTMINSTER AVE STE 102
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City | GARDEN GROVE
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State | CA
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Zip | 92843-4800
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Country | US
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Telephone | 714-530-8900
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Fax | 714-509-0605
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Provider Business Mailing Address
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Address Line | 10212 WESTMINSTER AVE STE 102
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City | GARDEN GROVE
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State | CA
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Zip | 92843-4800
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Country | US
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Telephone | 714-530-8900
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Fax | 714-509-0605
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Authorized Official
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Title or Position | OWNER/MANAGING MEMBER
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Name | SIVARAMAN K GOUNDER
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Credential | MD
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Telephone | 908-361-0185
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 207YP0228X
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Taxonomy Name | Pediatric Otolaryngology Physician
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 208200000X
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Taxonomy Name | Plastic Surgery Physician
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number |
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License Number State |
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