Provider Demographics
NPI:1831154673
Name:GURSAHANI, PUSHPA (MD)
Entity type:Individual
Prefix:DR
First Name:PUSHPA
Middle Name:
Last Name:GURSAHANI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1859 S UNION ST UNIT 41
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92805-7446
Mailing Address - Country:US
Mailing Address - Phone:714-267-3444
Mailing Address - Fax:
Practice Address - Street 1:1859 S UNION ST UNIT 41
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92805-7446
Practice Address - Country:US
Practice Address - Phone:714-267-3444
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-17
Last Update Date:2025-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC51340208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOA13804Medicare UPIN