Provider Demographics
NPI:1033154927
Name:HUNDAL, RAVINDER S (MD)
Entity Type:Individual
Prefix:DR
First Name:RAVINDER
Middle Name:S
Last Name:HUNDAL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:DEPT 34929
Mailing Address - Street 2:P.O. BOX 39000
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94139-0001
Mailing Address - Country:US
Mailing Address - Phone:925-952-2828
Mailing Address - Fax:925-952-2850
Practice Address - Street 1:401 GREGORY LN
Practice Address - Street 2:SUITE 104
Practice Address - City:PLEASANT HILL
Practice Address - State:CA
Practice Address - Zip Code:94523-2800
Practice Address - Country:US
Practice Address - Phone:925-682-2401
Practice Address - Fax:925-674-4721
Is Sole Proprietor?:No
Enumeration Date:2006-06-17
Last Update Date:2012-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA46299207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A462990Medicaid
CA00A462990Medicaid
CA080132474Medicare PIN
CA00A462991Medicare PIN