Healthcare Provider Details

I. General information

NPI: 1508807462
Provider Name (Legal Business Name): SANDEEP KUNWAR M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2006
Last Update Date: 09/20/2021
Certification Date: 09/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 MOWRY AVE SUITE 222
FREMONT CA
94538-1605
US

IV. Provider business mailing address

505 PARNASSUS AVE M-780
SAN FRANCISCO CA
94143-0112
US

V. Phone/Fax

Practice location:
  • Phone: 510-818-1160
  • Fax:
Mailing address:
  • Phone: 415-353-7500
  • Fax: 415-353-2617

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License NumberG081422
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: