Healthcare Provider Details

I. General information

NPI: 1003455460
Provider Name (Legal Business Name): RANVINDER KAUR RAI MD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/03/2020
Last Update Date: 01/03/2020
Certification Date: 01/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

39676 MISSION BLVD
FREMONT CA
94539-3000
US

IV. Provider business mailing address

39676 MISSION BLVD
FREMONT CA
94539-3000
US

V. Phone/Fax

Practice location:
  • Phone: 510-556-3120
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: RANVINDER RAI
Title or Position: PSYCHIATRIST
Credential: MD
Phone: 510-556-3120