Healthcare Provider Details

I. General information

NPI: 1467329904
Provider Name (Legal Business Name): BASS MEDICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/20/2025
Last Update Date: 10/20/2025
Certification Date: 10/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12677 ALCOSTA BLVD STE 180
SAN RAMON CA
94583-4423
US

IV. Provider business mailing address

2637 SHADELANDS DR
WALNUT CREEK CA
94598-2512
US

V. Phone/Fax

Practice location:
  • Phone: 925-464-1982
  • Fax: 925-464-2042
Mailing address:
  • Phone: 925-627-3424
  • Fax: 925-627-3560

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: INEZ WONDEH
Title or Position: COO
Credential:
Phone: 925-948-8154