Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223G0001X | General Practice | 58334 | CA |
N | 213EG0000X | General Practice | 58334 | CA |
Y | 1223S0112X | Oral and Maxillofacial Surgeon | 58334 | CA |
NPI | 1033346077 |
---|---|
Provider Name | David Sasha Ganji |
First Address | Lomita, CA 90717-2722 |
Second Address | Lomita, CA 90717-2722 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/06/2009 |
Last Update Date | 02/05/2019 |