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General NPI Number Information
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NPI Number | 1326338526
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Entity Type | Individual
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Provider Name | SUDEEP ROY MD
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Gender | Male
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Dates
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Enumeration Date | 04/10/2011
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Last Update Date | 07/02/2024
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Provider Practice Location Address
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Address Line | 800 POLLARD RD STE A
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City | LOS GATOS
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State | CA
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Zip | 95032-1432
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Country | US
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Telephone | 408-688-2082
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Fax | 408-866-4270
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Provider Business Mailing Address
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Address Line | 800 POLLARD RD STE A
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City | LOS GATOS
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State | CA
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Zip | 95032-1432
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Country | US
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Telephone | 408-688-2082
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Fax | 408-866-4270
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207YS0123X
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Taxonomy Name | Facial Plastic Surgery Physician
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License Number | 160542
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License Number State | CA
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