Healthcare Provider Details

I. General information

NPI: 1760032007
Provider Name (Legal Business Name): VIJAY MUNAGALA DDS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/18/2019
Last Update Date: 09/18/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20212 REDWOOD RD STE 101
CASTRO VALLEY CA
94546-4324
US

IV. Provider business mailing address

2245 TAHITI DR
SAN RAMON CA
94582-1432
US

V. Phone/Fax

Practice location:
  • Phone: 510-886-6416
  • Fax: 510-886-4827
Mailing address:
  • Phone: 240-529-5987
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. VIJAY MUNAGALA
Title or Position: DENTIST
Credential: DDS
Phone: 510-886-6416