Provider Demographics
NPI:1730197609
Name:JOGANI, PIYUSH K (MD)
Entity type:Individual
Prefix:MR
First Name:PIYUSH
Middle Name:K
Last Name:JOGANI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 280204
Mailing Address - Street 2:
Mailing Address - City:NORTHRIDGE
Mailing Address - State:CA
Mailing Address - Zip Code:91328
Mailing Address - Country:US
Mailing Address - Phone:818-885-9200
Mailing Address - Fax:818-885-9201
Practice Address - Street 1:18250 ROSCOE BLVD
Practice Address - Street 2:SUITE # 310
Practice Address - City:NORTHRIDGE
Practice Address - State:CA
Practice Address - Zip Code:91325-4226
Practice Address - Country:US
Practice Address - Phone:818-885-9200
Practice Address - Fax:818-885-9201
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-04
Last Update Date:2015-03-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA39138207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A391380Medicaid
CAA39138Medicare ID - Type Unspecified
CA00A391380Medicaid