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NPI Code Detail

MEDICARE: NIKITA CHAND GORE M.D.

MEDICARE: NIKITA CHAND GORE M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1390200000XStudent in an Organized Health Care Education/Training Program
2207Q00000XFamily Medicine PhysicianA169850CA

General Provider Information

NPI Number : 1265965107
Entity Type Code : Individual
Provider Name (Legal Business Name) : NIKITA CHAND GORE M.D.
Provider Business Mailing Address
First Line : 75 ROWLAND WAY STE 200
Second Line :
City : NOVATO
State : CA
Zip : 94945-5054
Country : US
Telephone Number : 415-897-9664
Fax Number :
Provider Business Practice Location Address
First Line : 75 ROWLAND WAY STE 200
Second Line :
City : NOVATO
State : CA
Zip : 94945-5054
Country : US
Telephone Number : 415-897-9664
Fax Number : 415-897-2446
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/07/2017
Last Update Date : 04/12/2021

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