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CHABOT UROLOGY MEDICAL ASSOCIATES A PROFESSIONAL CORP. NPI 1679629968


NPI Information

NPI: 1679629968
Provider Name: CHABOT UROLOGY MEDICAL ASSOCIATES, A PROFESSIONAL CORP.

Doing Business As: CHABOT UROLOGY MEDICAL ASSOCIATES, A PROFESSIONAL CORP.

Classification: Urology - 208800000X
Entity Type: Organization

CLIA Number: 05D2016786

Address:
20055 LAKE CHABOT RD STE 310
CASTRO VALLEY, CA
ZIP 94546
Phone: (510) 889-9166
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CHABOT UROLOGY MEDICAL ASSOCIATES, A PROFESSIONAL CORP. is an urology in Castro Valley, CA. The provider is a urologist manages benign and malignant medical and surgical disorders of the genitourinary system and the adrenal gland. This specialist has comprehensive knowledge of and skills in endoscopic, percutaneous and open surgery of congenital and acquired conditions of the urinary and reproductive systems and their contiguous structures. CHABOT UROLOGY MEDICAL ASSOCIATES, A PROFESSIONAL CORP. NPI is 1679629968. The provider is registered as an organization entity type and is a single specialty group.
The provider Is Doing Business As Chabot Urology Medical Associates, A Professional Corp..

The provider's business location address is:

20055 LAKE CHABOT RD STE 310
CASTRO VALLEY, CA
ZIP 94546-334
Phone: (510) 889-9166

The provider's authorized official is Sourjya Prakash Misra .
The authorized official title is President and has the following contact phone number (510) 889-9166.

The CLIA number assigned to this NPI record is 05D2016786 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 1/27/2007 and was last updated on 7/11/2023.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1208800000XUrologyA49141CALIFORNIAYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.Other Provider IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
1E85288MEDICAIDCALIFORNIA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

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