1902345747 NPI number — PUJA THAKKAR, D.O., MEDICAL CORPORATION

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1902345747 NPI number — PUJA THAKKAR, D.O., MEDICAL CORPORATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PUJA THAKKAR, D.O., MEDICAL CORPORATION
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
GOLDEN GATE SLEEP CENTER
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1902345747
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/15/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
400 EL CERRO BLVD
Provider Second Line Business Mailing Address:
SUITE 107
Provider Business Mailing Address City Name:
DANVILLE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94526-1731
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
925-820-4472
Provider Business Mailing Address Fax Number:
925-820-2650

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
400 EL CERRO BLVD
Provider Second Line Business Practice Location Address:
SUITE 107
Provider Business Practice Location Address City Name:
DANVILLE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94526-1731
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
925-820-4472
Provider Business Practice Location Address Fax Number:
925-820-2650
Provider Enumeration Date:
02/13/2017

Additional Information

Authorized Official

Authorized Official Last Name:
THAKKAR
Authorized Official First Name:
PUJA
Authorized Official Middle Name:
ANIL
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
925-820-4472

Provider Taxonomy Codes

  • Taxonomy code: 207RS0012X , with the licence number:  20A12339 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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