Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | A90302 | CA |
Y | 207XX0005X | Sports Medicine Orthopaedic Surgeon | A90302 | CA |
NPI | 1164642583 |
---|---|
Provider Name | Rishi Garg |
First Address | Pasadena, CA 91109-0730 |
Second Address | Arcadia, CA 91007-3492 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/04/2007 |
Last Update Date | 04/10/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1164642583 | (05) | CA |
CB111X | MEDICARE (01) | CA |
P00941215 | MEDICARE RAIL ROAD (01) | CA |