=====================================================
General NPI Number Information
=====================================================
NPI Number | 1144796095
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MR. SUKHJIT SINGH GHUMAN
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/18/2018
-----------------------------------------------------
Last Update Date | 10/18/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9097 E DESERT COVE AVE STE 100
-----------------------------------------------------
City | SCOTTSDALE
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85260-6276
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 408-609-4200
-----------------------------------------------------
Fax | 408-609-4233
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 9097 E DESERT COVE AVE STE 100
-----------------------------------------------------
City | SCOTTSDALE
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85260-6276
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 408-609-4200
-----------------------------------------------------
Fax | 408-609-4233
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261Q00000X
-----------------------------------------------------
Taxonomy Name | Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------