Healthcare Provider Details

I. General information

NPI: 1417348319
Provider Name (Legal Business Name): JYOTI BHAT, MD, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/12/2015
Last Update Date: 02/12/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2182 EAST ST
CONCORD CA
94520-2012
US

IV. Provider business mailing address

2182 EAST ST
CONCORD CA
94520-2012
US

V. Phone/Fax

Practice location:
  • Phone: 925-685-4224
  • Fax: 877-208-3997
Mailing address:
  • Phone: 925-685-4224
  • Fax: 877-208-3997

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License NumberA110293
License Number StateCA

VIII. Authorized Official

Name: JYOTI BHAT
Title or Position: OWNER
Credential: MD
Phone: 925-685-4224