Provider Demographics
NPI:1659070357
Name:PALAN, SONIYA
Entity Type:Individual
Prefix:
First Name:SONIYA
Middle Name:
Last Name:PALAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30341 MERIDIEN CIR
Mailing Address - Street 2:
Mailing Address - City:UNION CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94587-1548
Mailing Address - Country:US
Mailing Address - Phone:408-583-7408
Mailing Address - Fax:
Practice Address - Street 1:3246 W GRANT LINE RD
Practice Address - Street 2:
Practice Address - City:TRACY
Practice Address - State:CA
Practice Address - Zip Code:95304-8427
Practice Address - Country:US
Practice Address - Phone:209-213-7808
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-01
Last Update Date:2023-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA108637122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist