Healthcare Provider Details

I. General information

NPI: 1689376618
Provider Name (Legal Business Name): MEGHA KAMAL GANGADHAR MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/21/2023
Last Update Date: 08/13/2026
Certification Date: 08/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

450 BROADWAY ST
REDWOOD CITY CA
94063-3132
US

IV. Provider business mailing address

450 BROADWAY ST
REDWOOD CITY CA
94063-3132
US

V. Phone/Fax

Practice location:
  • Phone: 650-723-6601
  • Fax:
Mailing address:
  • Phone: 650-723-6601
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QS1201X
TaxonomySleep Medicine (Family Medicine) Physician
License NumberA207786
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number125082917
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: