Healthcare Provider Details

I. General information

NPI: 1881860989
Provider Name (Legal Business Name): N S HUNDAL MD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/08/2008
Last Update Date: 05/08/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1516 COLORADO AVE
TURLOCK CA
95380-7505
US

IV. Provider business mailing address

1516 COLORADO AVE
TURLOCK CA
95380-7505
US

V. Phone/Fax

Practice location:
  • Phone: 209-668-5454
  • Fax:
Mailing address:
  • Phone: 209-668-5454
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA672190
License Number StateCA

VIII. Authorized Official

Name: GINA WALLACE
Title or Position: BILLING AGENT
Credential:
Phone: 209-571-8330