Provider Demographics
NPI:1902345747
Name:PUJA THAKKAR, D.O., MEDICAL CORPORATION
Entity Type:Organization
Organization Name:PUJA THAKKAR, D.O., MEDICAL CORPORATION
Other - Org Name:GOLDEN GATE SLEEP CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PUJA
Authorized Official - Middle Name:ANIL
Authorized Official - Last Name:THAKKAR
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:925-820-4472
Mailing Address - Street 1:400 EL CERRO BLVD
Mailing Address - Street 2:SUITE 107
Mailing Address - City:DANVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:94526-1731
Mailing Address - Country:US
Mailing Address - Phone:925-820-4472
Mailing Address - Fax:925-820-2650
Practice Address - Street 1:400 EL CERRO BLVD
Practice Address - Street 2:SUITE 107
Practice Address - City:DANVILLE
Practice Address - State:CA
Practice Address - Zip Code:94526-1731
Practice Address - Country:US
Practice Address - Phone:925-820-4472
Practice Address - Fax:925-820-2650
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-13
Last Update Date:2024-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A12339207RS0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep MedicineGroup - Single Specialty