Basic Information
| Provider Information | |||||||||
| NPI: | 1407993595 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | GEXIN AND ASSOCIATES, A MEDICAL CORPORATION | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5 HOLLAND | ||||||||
| Address2: | SUITE 101 | ||||||||
| City: | IRVINE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 926182568 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9495882190 | ||||||||
| FaxNumber: | 9495882199 | ||||||||
| Practice Location | |||||||||
| Address1: | 15825 LAGUNA CANYON RD STE 100 | ||||||||
| Address2: | |||||||||
| City: | IRVINE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 926182126 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9496796700 | ||||||||
| FaxNumber: | 9493879530 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/30/2007 | ||||||||
| LastUpdateDate: | 11/16/2017 | ||||||||
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| AuthorizedOfficialLastName: | TANG | ||||||||
| AuthorizedOfficialFirstName: | GEXIN | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 9498361888 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | A69406 | CA | N | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Anesthesiology | 207L00000X | 69406 | CA | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Anesthesiology |
ID Information
| ID | Type | State | Issuer | Description | A69406 | 01 | CA | PRESIDENT'S LICENSE NUMBE | OTHER | 00A694060 | 05 | CA | MEDICAID |