Provider Demographics
NPI:1720214125
Name:EAST BAY HAND & PLASTIC SURGERY CENTER INC.
Entity Type:Organization
Organization Name:EAST BAY HAND & PLASTIC SURGERY CENTER INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PRASAD
Authorized Official - Middle Name:GANGADHAR
Authorized Official - Last Name:KILARU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:510-648-2626
Mailing Address - Street 1:2626 GRAPEVINE TER
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94539-6079
Mailing Address - Country:US
Mailing Address - Phone:510-648-2626
Mailing Address - Fax:866-383-0295
Practice Address - Street 1:39141 CIVIC CENTER DR
Practice Address - Street 2:SUITE 110
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94538-5818
Practice Address - Country:US
Practice Address - Phone:510-648-2626
Practice Address - Fax:866-383-0295
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-31
Last Update Date:2009-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA60104208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG71216Medicare UPIN