Healthcare Provider Details

I. General information

NPI: 1669960217
Provider Name (Legal Business Name): OBIK CHOWDHURY
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/30/2018
Last Update Date: 08/16/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 E SCHOOL AVE
VISALIA CA
93291-5032
US

IV. Provider business mailing address

305 E CENTER AVE
VISALIA CA
93291-6331
US

V. Phone/Fax

Practice location:
  • Phone: 877-960-3426
  • Fax: 559-734-1247
Mailing address:
  • Phone: 559-737-4700
  • Fax: 559-734-1247

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDDS104090
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: