=====================================================
General NPI Number Information
=====================================================
NPI Number | 1720173412
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SAWTANTRA KUMAR CHOPRA MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/04/2006
-----------------------------------------------------
Last Update Date | 01/24/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1401 SPANOS COURT SUITE 128
-----------------------------------------------------
City | MODESTO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95355
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 209-525-3112
-----------------------------------------------------
Fax | 209-525-3126
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1401 SPANOS COURT SUITE 128
-----------------------------------------------------
City | MODESTO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95355
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 209-525-3112
-----------------------------------------------------
Fax | 209-525-3126
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RP1001X
-----------------------------------------------------
Taxonomy Name | Pulmonary Disease Physician
-----------------------------------------------------
License Number | A297711
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------