Provider Demographics
NPI:1003234501
Name:WADHWA, SANYA (MD)
Entity Type:Individual
Prefix:
First Name:SANYA
Middle Name:
Last Name:WADHWA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 FRANK H OGAWA PLZ STE 355
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94612-2088
Mailing Address - Country:US
Mailing Address - Phone:510-433-7821
Mailing Address - Fax:510-433-7831
Practice Address - Street 1:300 FRANK H OGAWA PLZ STE 355
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94612-2088
Practice Address - Country:US
Practice Address - Phone:510-444-3297
Practice Address - Fax:510-444-6421
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-01
Last Update Date:2024-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA145736207RG0100X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA145736OtherMEDICAL LICENSE