Healthcare Provider Details

I. General information

NPI: 1710743380
Provider Name (Legal Business Name): SUNDEEP GRANDHE MD CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/22/2024
Last Update Date: 11/29/2024
Certification Date: 11/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 OLD RIVER RD STE 105
BAKERSFIELD CA
93311-9505
US

IV. Provider business mailing address

2012 NORWICH WAY
BAKERSFIELD CA
93311-2910
US

V. Phone/Fax

Practice location:
  • Phone: 661-327-9300
  • Fax: 661-327-9301
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207RH0002X
TaxonomyHospice and Palliative Medicine (Internal Medicine) Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: DR. SUNDEEP GRANDHE
Title or Position: PRESIDENT
Credential: MD
Phone: 661-529-5558