Healthcare Provider Details

I. General information

NPI: 1316176035
Provider Name (Legal Business Name): SANJEEV K. GOSWAMI, MD, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/02/2009
Last Update Date: 07/02/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1801 E MARCH LN C 300
STOCKTON CA
95210-6629
US

IV. Provider business mailing address

1801 E MARCH LN C 300
STOCKTON CA
95210-6629
US

V. Phone/Fax

Practice location:
  • Phone: 209-464-6422
  • Fax: 209-464-0193
Mailing address:
  • Phone: 209-464-6422
  • Fax: 209-464-0193

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License NumberA88835
License Number StateCA

VIII. Authorized Official

Name: DR. SANJEEV K GOSWAMI
Title or Position: PRESIDENT
Credential: MD
Phone: 209-464-6422