Provider Demographics
NPI:1871385476
Name:EJIGU MEDICAL SERVICES
Entity type:Organization
Organization Name:EJIGU MEDICAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INTERNIST,PULMONOLOGIST,INTENSIVIST
Authorized Official - Prefix:
Authorized Official - First Name:TESHAGER
Authorized Official - Middle Name:GASHAW
Authorized Official - Last Name:EJIGU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:571-239-7049
Mailing Address - Street 1:3621 MARTIN LUTHER KING JR BLVD STE 6
Mailing Address - Street 2:
Mailing Address - City:LYNWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90262-3512
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3621 MARTIN LUTHER KING JR BLVD STE 6
Practice Address - Street 2:
Practice Address - City:LYNWOOD
Practice Address - State:CA
Practice Address - Zip Code:90262-3512
Practice Address - Country:US
Practice Address - Phone:310-537-1503
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-05-20
Last Update Date:2025-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
No261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPain