Provider Demographics
NPI:1548248032
Name:COMPASSIONATE CANCER CARE MEDICAL GROUP, INC.
Entity type:Organization
Organization Name:COMPASSIONATE CANCER CARE MEDICAL GROUP, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN./OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:HARESH
Authorized Official - Middle Name:S
Authorized Official - Last Name:JHANGIANI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:714-698-0300
Mailing Address - Street 1:11180 WARNER AVE STE 351
Mailing Address - Street 2:
Mailing Address - City:FOUNTAIN VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92708-7516
Mailing Address - Country:US
Mailing Address - Phone:714-698-0300
Mailing Address - Fax:714-698-0303
Practice Address - Street 1:11180 WARNER AVE STE 351
Practice Address - Street 2:
Practice Address - City:FOUNTAIN VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92708-7516
Practice Address - Country:US
Practice Address - Phone:714-698-0300
Practice Address - Fax:714-698-0303
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-04
Last Update Date:2018-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA38872174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ05040ZOtherBLUE SHIELD
CAGR0093941Medicaid
CAZZZ64478ZOtherBLUE SHIELD
CAZZZ05039ZOtherBLUE SHIELD
CAGR0093942Medicaid
CAGR0093940Medicaid
CAGR0093941Medicaid
CAZZZ05040ZOtherBLUE SHIELD
CAGR0093940Medicaid