Provider Demographics
NPI:1598497224
Name:3PRONG
Entity Type:Organization
Organization Name:3PRONG
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DEEPAK
Authorized Official - Middle Name:
Authorized Official - Last Name:KUMAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:510-952-1190
Mailing Address - Street 1:39159 PASEO PADRE PKWY STE 121
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94538-1600
Mailing Address - Country:US
Mailing Address - Phone:510-952-1190
Mailing Address - Fax:510-972-5976
Practice Address - Street 1:1375 BURLINGAME AVE STE L2
Practice Address - Street 2:
Practice Address - City:BURLINGAME
Practice Address - State:CA
Practice Address - Zip Code:94010-4131
Practice Address - Country:US
Practice Address - Phone:510-952-1190
Practice Address - Fax:510-972-5976
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-30
Last Update Date:2022-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty