Provider Demographics
NPI:1104938679
Name:LOHIYA, GHANSHYAM (MD)
Entity type:Individual
Prefix:
First Name:GHANSHYAM
Middle Name:
Last Name:LOHIYA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1120 W. WARNER AV
Mailing Address - Street 2:A
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92707
Mailing Address - Country:US
Mailing Address - Phone:714-444-4448
Mailing Address - Fax:714-444-9892
Practice Address - Street 1:1120 W. WARNER
Practice Address - Street 2:A
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92707
Practice Address - Country:US
Practice Address - Phone:714-444-4448
Practice Address - Fax:714-444-9892
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2008-10-22
Deactivation Date:2008-08-25
Deactivation Code:
Reactivation Date:2008-10-01
Provider Licenses
StateLicense IDTaxonomies
CAA342432083X0100X, 2083P0500X, 2083P0901X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083P0500XAllopathic & Osteopathic PhysiciansPreventive MedicinePreventive Medicine/Occupational Environmental Medicine
No2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational Medicine
No2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A342430Medicaid
CAWA34243AMedicare PIN
CA00A342430Medicaid
CAA34243Medicare PIN