Provider Demographics
NPI:1104081710
Name:HARINDER S GOGIA MD INC
Entity type:Organization
Organization Name:HARINDER S GOGIA MD INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:HARINDER
Authorized Official - Middle Name:S
Authorized Official - Last Name:GOGIA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:714-568-6600
Mailing Address - Street 1:801 N TUSTIN AVE
Mailing Address - Street 2:SUITE 706
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92705-3612
Mailing Address - Country:US
Mailing Address - Phone:714-568-6600
Mailing Address - Fax:714-245-0260
Practice Address - Street 1:801 N TUSTIN AVE
Practice Address - Street 2:SUITE 706
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92705-3612
Practice Address - Country:US
Practice Address - Phone:714-568-6600
Practice Address - Fax:714-245-0260
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-23
Last Update Date:2008-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA50283207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0095890Medicaid
CAX71568Medicare UPIN
WA50283DMedicare PIN
CAW15717AMedicare PIN