# BASS MEDICAL GROUP

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1649646282
- **Authorized official:** MS. INEZ WONDEH (COO)
- **Authorized official phone:** (925) 378-4512

## Contact information

- **Practice address:** 5924 STONERIDGE DR STE 202, PLEASANTON, CA 94588-5400
- **Practice address phone:** (925) 600-7020
- **Practice address fax:** (925) 600-7010
- **Mailing address:** 2637 SHADELANDS DR, WALNUT CREEK, CA 94598-2512
- **Mailing address phone:** (925) 948-8143
- **Mailing address fax:** (925) 215-4540

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207X00000X | Orthopaedic Surgery Physician | — | NULL | Yes |
| 207X00000X | Orthopaedic Surgery Physician | — | — | Yes |
| 207XX0005X | Sports Medicine (Orthopaedic Surgery) Physician | — | NULL | — |
| 207XX0005X | Sports Medicine (Orthopaedic Surgery) Physician | — | — | — |

## Other

- **Enumeration date:** 08/18/2015
- **Last updated:** 10/18/2023

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 1619916293 | INDIVIDUAL NPI | — |
| 01 | — | 736010002 | NSC MEDICARE | — |