Organization
MOWRY MEDICAL GROUP, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. AJIT PAL SINGH SANDHU M.D. (PRESIDENT AND CEO)
(510) 790-1511
Entity
Organization
Contact information
Practice address
680 MOWRY AVE, FREMONT, CA 94536-4113
(510) 790-1511
(510) 790-8820
Mailing address
680 MOWRY AVE, FREMONT, CA 94536-4113
(510) 790-1511
(510) 790-8820
Taxonomy
Speciality
Code
Description
License number
State
207RP1001X
Pulmonary Disease Physician
Primary
A34658
CA
208VP0000X
Pain Medicine Physician
A34658
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00A346580
—
CA
01
—
ZZZ05452Z
BLUE SHIELD OF CA PROV.#
CA
Enumeration date
08/23/2006
Last updated
10/30/2012
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