Healthcare Provider Details

I. General information

NPI: 1396925327
Provider Name (Legal Business Name): VIJAY CHOPRA DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/07/2007
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9184 E STOCKTON BLVD
ELK GROVE CA
95624-9510
US

IV. Provider business mailing address

9184 E STOCKTON BLVD
ELK GROVE CA
95624-9510
US

V. Phone/Fax

Practice location:
  • Phone: 916-714-3195
  • Fax:
Mailing address:
  • Phone: 916-686-1101
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number12158
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number56816
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: