Provider Demographics
NPI:1922397645
Name:PATEL, CHIRAG MADHUSUDAN (DMD, MD)
Entity Type:Individual
Prefix:DR
First Name:CHIRAG
Middle Name:MADHUSUDAN
Last Name:PATEL
Suffix:
Gender:M
Credentials:DMD, MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:UCSF DEPT OF ORAL & MAXILLOFACIAL SURGERY
Mailing Address - Street 2:BOX 0440, 521 PARNASSUS AVE, CLINIC SCI C522
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94143-0440
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:707 PARNASSUS AVE, RM D1201
Practice Address - Street 2:UCSF ORAL & FACIAL SURGERY CENTER
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94143
Practice Address - Country:US
Practice Address - Phone:415-476-1316
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-04-04
Last Update Date:2013-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA603341223S0112X
CAA122633204E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
No204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial Surgery