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General NPI Number Information
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NPI Number | 1700993219
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Entity Type | Organization
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Legal Business Name | MOWRY MEDICAL GROUP, INC.
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Dates
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Enumeration Date | 08/23/2006
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Last Update Date | 10/30/2012
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Provider Practice Location Address
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Address Line | 680 MOWRY AVE
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City | FREMONT
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State | CA
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Zip | 94536-4113
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Country | US
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Telephone | 510-790-1511
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Fax | 510-790-8820
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Provider Business Mailing Address
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Address Line | 680 MOWRY AVE
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City | FREMONT
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State | CA
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Zip | 94536-4113
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Country | US
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Telephone | 510-790-1511
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Fax | 510-790-8820
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Authorized Official
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Title or Position | PRESIDENT AND CEO
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Name | DR. AJIT PAL SINGH SANDHU
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Credential | M.D.
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Telephone | 510-790-1511
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208VP0000X
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Taxonomy Name | Pain Medicine Physician
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License Number | A34658
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 207RP1001X
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Taxonomy Name | Pulmonary Disease Physician
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License Number | A34658
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License Number State | CA
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