Provider Demographics
NPI:1417026493
Name:GANDHI, RADHAKRISHAN S (MD)
Entity type:Individual
Prefix:DR
First Name:RADHAKRISHAN
Middle Name:S
Last Name:GANDHI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:RAY
Other - Middle Name:S
Other - Last Name:GANDHI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:28241 CROWN VALLEY PKWY # F337
Mailing Address - Street 2:
Mailing Address - City:LAGUNA NIGUEL
Mailing Address - State:CA
Mailing Address - Zip Code:92677-4441
Mailing Address - Country:US
Mailing Address - Phone:949-305-9053
Mailing Address - Fax:
Practice Address - Street 1:520 SUPERIOR AVE STE 220
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92663-3671
Practice Address - Country:US
Practice Address - Phone:949-515-4515
Practice Address - Fax:949-515-4508
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-06
Last Update Date:2025-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA053184207RI0011X, 207UN0901X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
No207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional CardiologyGroup - Multi-Specialty
No207UN0901XAllopathic & Osteopathic PhysiciansNuclear MedicineNuclear CardiologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A531840Medicaid
CAA53184Medicare ID - Type Unspecified
CAG 77563Medicare UPIN