Healthcare Provider Details

I. General information

NPI: 1336700863
Provider Name (Legal Business Name): SUDHINDER KOUSHIK MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/25/2019
Last Update Date: 07/07/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

606 SARATOGA AVE
SAN JOSE CA
95129-2000
US

IV. Provider business mailing address

606 SARATOGA AVE
SAN JOSE CA
95129-2000
US

V. Phone/Fax

Practice location:
  • Phone: 408-984-1010
  • Fax:
Mailing address:
  • Phone: 408-984-1010
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number2019021888
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number2020013957
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: