=====================================================
General NPI Number Information
=====================================================
NPI Number | 1487147047
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SUKH CHAUHAN DENTAL CORP
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/08/2018
-----------------------------------------------------
Last Update Date | 06/08/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4020 RAILROAD AVE
-----------------------------------------------------
City | PITTSBURG
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94565-6532
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 925-890-4193
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2567 GRAPPA PL
-----------------------------------------------------
City | PLEASANTON
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94566-6476
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 925-890-4193
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. SUKH CHAUHAN
-----------------------------------------------------
Credential | DDS,BDS
-----------------------------------------------------
Telephone | 925-890-4193
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number | 62899
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------