Organization
MOWRY MEDICAL GROUP, INC.
Active
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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