Provider Demographics
NPI:1700257789
Name:GIMHA S GUNAWARDANA M D INC
Entity type:Organization
Organization Name:GIMHA S GUNAWARDANA M D INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GIMHA
Authorized Official - Middle Name:SUDHANI
Authorized Official - Last Name:GUNAWARDANA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:909-965-1215
Mailing Address - Street 1:999 SAN BERNARDINO RD
Mailing Address - Street 2:
Mailing Address - City:UPLAND
Mailing Address - State:CA
Mailing Address - Zip Code:91786-4920
Mailing Address - Country:US
Mailing Address - Phone:909-985-2811
Mailing Address - Fax:909-524-1943
Practice Address - Street 1:255 E BONITA AVE
Practice Address - Street 2:#101
Practice Address - City:POMONA
Practice Address - State:CA
Practice Address - Zip Code:91767-1923
Practice Address - Country:US
Practice Address - Phone:909-524-1940
Practice Address - Fax:909-524-1943
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-15
Last Update Date:2024-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA101531207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1720274921OtherINDIVIDUAL NPI