Healthcare Provider Details

I. General information

NPI: 1003101205
Provider Name (Legal Business Name): DR. SUJEEV VHAN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/15/2011
Last Update Date: 06/15/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3405 MCHENRY AVE T-0273
MODESTO CA
95350-1445
US

IV. Provider business mailing address

3405 MCHENRY AVE T-0273
MODESTO CA
95350-1445
US

V. Phone/Fax

Practice location:
  • Phone: 209-523-6210
  • Fax:
Mailing address:
  • Phone: 209-523-6210
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number58618
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: