Healthcare Provider Details

I. General information

NPI: 1134756984
Provider Name (Legal Business Name): PRABHDEEP UPPAL DO, MS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2020
Last Update Date: 07/22/2026
Certification Date: 07/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

520 ILLINOIS ST
SAN FRANCISCO CA
94143-2501
US

IV. Provider business mailing address

4755 OGLETOWN STANTON RD 2ND FLOOR AMMON BUILDING
NEWARK DE
19718-2200
US

V. Phone/Fax

Practice location:
  • Phone: 415-353-9414
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number20A23737
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: