Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207U00000X | Nuclear Medicine Specialist | A79514 | CA |
NPI | 1043276900 |
---|---|
Provider Name | Dr. Puneet Chandak |
First Address | San Jose, CA 95128-2000 |
Second Address | Fremont, CA 94538-1725 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/04/2006 |
Last Update Date | 27/12/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
H70546 | (02) | CA |
ZZZ05957Z | MEDICARE GROUP ID (01) |