MEDICARE: DR. SONU MADAN DDS

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
1	122300000X	Dentist	50952	CA

General Provider Information

NPI Number	:	1962563122
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SONU MADAN DDS

Provider Business Mailing Address
First Line	:	1235 WILDWOOD AVE APT 384
Second Line	:
City	:	SUNNYVALE
State	:	CA
Zip	:	94089-2726
Country	:	US
Telephone Number	:	408-454-6176
Fax Number	:

Provider Business Practice Location Address
First Line	:	1871 CAMDEN AVE
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95124-2945
Country	:	US
Telephone Number	:	408-377-5700
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/12/2006
Last Update Date	:	07/08/2007

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