MEDICARE: SHOBHA TANDON M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207W00000X	Ophthalmology Physician	A53643	CA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	00A536430	OTHER	CA	MEDICARE PTAN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	00A536431	OTHER	CA	PTAN

General Provider Information

NPI Number	:	1811006513
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHOBHA TANDON M.D.

Provider Business Mailing Address
First Line	:	2 UNION SQ FL 1
Second Line	:
City	:	UNION CITY
State	:	CA
Zip	:	94587-4495
Country	:	US
Telephone Number	:	510-552-6167
Fax Number	:	510-431-5513

Provider Business Practice Location Address
First Line	:	2 UNION SQ FL 1
Second Line	:
City	:	UNION CITY
State	:	CA
Zip	:	94587-4495
Country	:	US
Telephone Number	:	510-431-5511
Fax Number	:	510-431-5513

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/29/2006
Last Update Date	:	08/14/2022

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Directions to “ SHOBHA TANDON M.D.” Practice Location

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