Healthcare Provider Details

I. General information

NPI: 1750448460
Provider Name (Legal Business Name): SUMIT SEN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/02/2007
Last Update Date: 11/07/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 TAYLOR BLVD SUITE 306
PLEASANT HILL CA
94523-2147
US

IV. Provider business mailing address

64 OAK KNOLL LOOP
WALNUT CREEK CA
94596-5417
US

V. Phone/Fax

Practice location:
  • Phone: 925-695-4859
  • Fax:
Mailing address:
  • Phone: 925-695-4859
  • Fax: 925-465-5857

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA60190
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: