Healthcare Provider Details

I. General information

NPI: 1316252414
Provider Name (Legal Business Name): SANJAY AGARWAL PROFESSIONAL MEDICAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/12/2010
Last Update Date: 05/07/2026
Certification Date: 05/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3155 KEARNEY ST STE 110
FREMONT CA
94538-2286
US

IV. Provider business mailing address

3155 KEARNEY ST STE 110
FREMONT CA
94538-2286
US

V. Phone/Fax

Practice location:
  • Phone: 408-418-0300
  • Fax: 408-418-0301
Mailing address:
  • Phone: 408-418-0300
  • Fax: 408-418-0301

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QS1200X
TaxonomySleep Disorder Diagnostic Clinic/Center
License NumberA104257
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License NumberA104257
License Number StateCA

VIII. Authorized Official

Name: DR. SANJAY KUMAR AGARWAL
Title or Position: CEO AND DIRECTOR
Credential: MD, FCCP, FAASM
Phone: 408-418-0300