Basic Information
| Provider Information | |||||||||
| NPI: | 1104895580 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GANESAN | ||||||||
| FirstName: | ANAND | ||||||||
| MiddleName: | K | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 513230 | ||||||||
| Address2: | UNIV DERMATOLOGY | ||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900513230 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7144568068 | ||||||||
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| Practice Location | |||||||||
| Address1: | 101 THE CITY DRIVE S | ||||||||
| Address2: | UCI MEDICAL CENTER | ||||||||
| City: | ORANGE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 928683201 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7144568068 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/16/2006 | ||||||||
| LastUpdateDate: | 02/14/2008 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207N00000X | M1101 | TX | Y | Allopathic & Osteopathic Physicians | Dermatology |
No ID Information.