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General NPI Number Information
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NPI Number | 1801287420
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Entity Type | Organization
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Legal Business Name | SHASHI D GANTI MD PC
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Dates
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Enumeration Date | 02/18/2015
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Last Update Date | 09/22/2024
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Provider Practice Location Address
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Address Line | 2147 MOWRY AVE STE D1
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City | FREMONT
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State | CA
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Zip | 94538-1724
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Country | US
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Telephone | 510-556-2153
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Fax | 510-556-2155
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Provider Business Mailing Address
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Address Line | 2147 MOWRY AVE STE D1
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City | FREMONT
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State | CA
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Zip | 94538-1724
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Country | US
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Telephone | 510-556-2153
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Fax |
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Authorized Official
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Title or Position | PRESIDENT/CEO
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Name | DR. SHASHI D GANTI
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Credential | MD
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Telephone | 559-433-5459
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | A38830
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License Number State | CA
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