Healthcare Provider Details

I. General information

NPI: 1932977444
Provider Name (Legal Business Name): GOPAL SAH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/13/2023
Last Update Date: 06/22/2026
Certification Date: 06/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2165 CUNNINGHAM DR
HAMPTON VA
23666-2569
US

IV. Provider business mailing address

622 W 168TH ST
NEW YORK NY
10032-3720
US

V. Phone/Fax

Practice location:
  • Phone: 757-251-0515
  • Fax: 757-896-3615
Mailing address:
  • Phone: 617-453-8117
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number0401420106
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: