Healthcare Provider Details

I. General information

NPI: 1780465211
Provider Name (Legal Business Name): GURU HARKRISHAN MEDICAL CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/10/2023
Last Update Date: 10/10/2023
Certification Date: 10/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 GURDWARA RD
FREMONT CA
94536-1509
US

IV. Provider business mailing address

300 GURDWARA RD
FREMONT CA
94536-1509
US

V. Phone/Fax

Practice location:
  • Phone: 650-430-0234
  • Fax:
Mailing address:
  • Phone: 650-430-0234
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. MANCHITRANJAN SINGH
Title or Position: CLINIC DIRECTOR
Credential:
Phone: 650-430-0234