Provider Demographics
NPI:1811006513
Name:TANDON, SHOBHA (MD)
Entity Type:Individual
Prefix:
First Name:SHOBHA
Middle Name:
Last Name:TANDON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:2 UNION SQ FL 1
Mailing Address - Street 2:
Mailing Address - City:UNION CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94587-4495
Mailing Address - Country:US
Mailing Address - Phone:510-552-6167
Mailing Address - Fax:510-431-5513
Practice Address - Street 1:2 UNION SQ FL 1
Practice Address - Street 2:
Practice Address - City:UNION CITY
Practice Address - State:CA
Practice Address - Zip Code:94587-4495
Practice Address - Country:US
Practice Address - Phone:510-431-5511
Practice Address - Fax:510-431-5513
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2022-08-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA53643207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A536431OtherPTAN
CA00A536430OtherMEDICARE PTAN