NPIMap

Organization Active NPI

Mowry Medical Group, Inc.

  • Pulmonary Disease Physician
  • Fremont, CA
National Provider Identifier
1700993219
Registry record updated Oct 30, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pulmonary Disease PhysicianTaxonomy code 207RP1001X
License
A34658 Issued in CA
Legal business name
MOWRY MEDICAL GROUP, INC.
Practice address
680 Mowry Ave
Fremont, CA 94536-4113
Phone
(510) 790-1511
Fax
(510) 790-8820
NPI assigned
Aug 23, 2006
Last updated
Oct 30, 2012By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 30, 2012

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Ajit Pal Singh Sandhu, M.D.NPI 1306953724
Title
President and Ceo
Phone
(510) 790-1511

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pulmonary Disease Physician 207RP1001X A34658 CA Primary
Pain Medicine Physician 208VP0000X A34658 CA

Addresses

Primary practice location

680 Mowry Ave
Fremont, CA 94536-4113

Mailing address

680 Mowry Ave
Fremont, CA 94536-4113
Phone (510) 790-1511

Other identifiers 2

IdentifierTypeStateIssuer
ZZZ05452ZOtherCABLUE SHIELD OF CA PROV.#
00A346580MedicaidCA

National Provider Directory

National Provider Directory

Locations

740 Mowry Ave
Ste 101
Fremont, CA 94536
Phone (510) 790-1511

Networks

  • BSC 65 PLUS INDIVIDUAL MAPDPlans: Blue Shield 65 Plus (HMO) (H0504-015-000, H0504); Blue Shield 65 Plus (HMO) (H0504-039-000, H0504); Blue Shield 65 Plus Plan 2 (HMO) (H0504-021-000, H0504); Blue Shield Inspire (HMO) (H0504-041-000, H0504); Blue Shield 65 Plus (HMO) (H0504-038-000, H0504); Blue Shield Inspire (HMO) (H0504-047-000, H0504); Blue Shield 65 Plus (HMO) (H0504-026-000, H0504); Blue Shield Advantage (HMO) (H0504-050-000, H0504); Blue Shield AdvantageOptimum Plan (HMO) (H5928-004-000, H5928); Blue Shield Inspire (HMO) (H0504-043-000, H0504)…

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1156291200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1351555200000",
    "number": "1700993219",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "680 MOWRY AVE",
            "city": "FREMONT",
            "state": "CA",
            "postal_code": "945364113",
            "telephone_number": "510-790-1511",
            "fax_number": "510-790-8820"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "680 MOWRY AVE",
            "city": "FREMONT",
            "state": "CA",
            "postal_code": "945364113",
            "telephone_number": "510-790-1511",
            "fax_number": "510-790-8820"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MOWRY MEDICAL GROUP, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-23",
        "last_updated": "2012-10-30",
        "status": "A",
        "authorized_official_last_name": "SANDHU",
        "authorized_official_first_name": "AJIT",
        "authorized_official_middle_name": "PAL SINGH",
        "authorized_official_title_or_position": "PRESIDENT AND CEO",
        "authorized_official_telephone_number": "510-790-1511",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207RP1001X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Pulmonary Disease",
            "state": "CA",
            "license": "A34658",
            "primary": true
        },
        {
            "code": "208VP0000X",
            "taxonomy_group": "",
            "desc": "Pain Medicine, Pain Medicine",
            "state": "CA",
            "license": "A34658",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD OF CA PROV.#",
            "identifier": "ZZZ05452Z",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00A346580",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Fremont, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 30, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.