Healthcare Provider Details

I. General information

NPI: 1205571734
Provider Name (Legal Business Name): KUNJ GOVIND PATEL MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/29/2022
Last Update Date: 04/29/2022
Certification Date: 04/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

95 W 11TH ST STE 10395W11
TRACY CA
95376-3959
US

IV. Provider business mailing address

DPT 2110 20500 BELSHAW AVE
CARSON CA
90746-3506
US

V. Phone/Fax

Practice location:
  • Phone: 415-754-3549
  • Fax:
Mailing address:
  • Phone: 415-754-3549
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QP3300X
TaxonomyPain Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: KUNJ GOVIND PATEL
Title or Position: DIRECTOR
Credential: MD
Phone: 314-282-7246