Healthcare Provider Details

I. General information

NPI: 1811488687
Provider Name (Legal Business Name): RUSDEEP SINGH MUNDAE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/28/2018
Last Update Date: 12/08/2025
Certification Date: 12/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

835 THIRD AVE STE A
CHULA VISTA CA
91911-1352
US

IV. Provider business mailing address

835 THIRD AVE STE A
CHULA VISTA CA
91911-1352
US

V. Phone/Fax

Practice location:
  • Phone: 619-425-7755
  • Fax: 619-425-2138
Mailing address:
  • Phone: 760-715-4188
  • Fax: 619-425-2138

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberA196430
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number315554
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: