Healthcare Provider Details

I. General information

NPI: 1508542374
Provider Name (Legal Business Name): SUSHMA PAI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2023
Last Update Date: 08/27/2026
Certification Date: 08/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3332 N TEXAS ST STE C
FAIRFIELD CA
94533-9806
US

IV. Provider business mailing address

1800 LACASSIE AVE
WALNUT CREEK CA
94596-1000
US

V. Phone/Fax

Practice location:
  • Phone: 797-399-9082
  • Fax:
Mailing address:
  • Phone: 972-345-4767
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number113796
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: