1295368322 NPI number — EAST BAY MEDICAL PROFESSIONAL CORPORATION

Table of content: (NPI 1295368322)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1295368322 NPI number — EAST BAY MEDICAL PROFESSIONAL CORPORATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EAST BAY MEDICAL PROFESSIONAL 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:
Provider Other Organization Name Type Code:
6
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:
1295368322
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/09/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3736 FALLON RD # 506
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DUBLIN
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94568-7400
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
925-334-7155
Provider Business Mailing Address Fax Number:
833-944-1899

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1393 SANTA RITA RD STE A
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PLEASANTON
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94566-5667
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
925-334-7155
Provider Business Practice Location Address Fax Number:
925-481-3818
Provider Enumeration Date:
02/18/2020

Additional Information

Authorized Official

Authorized Official Last Name:
KAUR
Authorized Official First Name:
JASPREET
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR
Authorized Official Telephone Number:
925-334-7155

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RE0101X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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