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General NPI Number Information
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NPI Number | 1720214125
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Entity Type | Organization
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Legal Business Name | EAST BAY HAND & PLASTIC SURGERY CENTER INC.
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Dates
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Enumeration Date | 05/31/2009
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Last Update Date | 05/31/2009
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Provider Practice Location Address
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Address Line | 39141 CIVIC CENTER DR SUITE 110
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City | FREMONT
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State | CA
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Zip | 94538-5818
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Country | US
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Telephone | 510-648-2626
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Fax | 866-383-0295
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Provider Business Mailing Address
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Address Line | 2626 GRAPEVINE TER
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City | FREMONT
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State | CA
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Zip | 94539-6079
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Country | US
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Telephone | 510-648-2626
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Fax | 866-383-0295
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. PRASAD GANGADHAR KILARU
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Credential | M.D.
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Telephone | 510-648-2626
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208200000X
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Taxonomy Name | Plastic Surgery Physician
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License Number | A60104
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License Number State | CA
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