Individual
DR. KIRAN GANGADHAR
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2428 SANTA MONICA BLVD, SANTA MONICA, CA 90404-2045
(310) 315-1000
Mailing address
19020 33RD AVE W, STE 210, LYNNWOOD, WA 98036-4748
(425) 563-1500
(425) 563-1374
Taxonomy
Speciality
Code
Description
License number
State
207U00000X
Nuclear Medicine Physician
MD60751368
WA
2085B0100X
Body Imaging Physician
MD60751368
WA
2085R0202X
Diagnostic Radiology Physician
Primary
A179353
CA
2085R0202X
Diagnostic Radiology Physician
MD60751368
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0390729
LNI-RADIA REST OF WA
WA
01
—
0390730
LNI-RADIA KING COUNTY
WA
01
—
0390731
LNI-SWEDISH RADIA EDMONDS
WA
01
—
0390732
LNI-EVERGREEN RADIA
WA
05
—
1679906580
—
WA
05
—
2036468
—
WA
Enumeration date
08/14/2013
Last updated
11/21/2023
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