Healthcare Provider Details

I. General information

NPI: 1689101578
Provider Name (Legal Business Name): SUNDEEP GRANDHE MD, HMDC, FAAHPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/22/2017
Last Update Date: 12/10/2025
Certification Date: 12/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1875 S GRANT ST STE 760
SAN MATEO CA
94402-2670
US

IV. Provider business mailing address

2625 E DIVISADERO ST
FRESNO CA
93721-1431
US

V. Phone/Fax

Practice location:
  • Phone: 888-227-8884
  • Fax:
Mailing address:
  • Phone: 559-443-2682
  • Fax: 559-443-2681

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174V00000X
TaxonomyClinical Ethicist
License NumberA165414
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207RH0002X
TaxonomyHospice and Palliative Medicine (Internal Medicine) Physician
License NumberA165414
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: