Provider Demographics
NPI:1982592705
Name:THE GORE MEDICAL GROUP INC.
Entity type:Organization
Organization Name:THE GORE MEDICAL GROUP INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:NIKITA
Authorized Official - Middle Name:CHAND
Authorized Official - Last Name:GORE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:909-374-1230
Mailing Address - Street 1:6755 MIRA MESA BLVD STE 123
Mailing Address - Street 2:#169
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92121-4311
Mailing Address - Country:US
Mailing Address - Phone:858-800-3850
Mailing Address - Fax:
Practice Address - Street 1:15708 POMERADO RD STE N201
Practice Address - Street 2:
Practice Address - City:POWAY
Practice Address - State:CA
Practice Address - Zip Code:92064-2066
Practice Address - Country:US
Practice Address - Phone:858-800-3850
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-06-27
Last Update Date:2025-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty