| Neelagiri Dental Group Inc | |
|
43625 Mission Blvd Ste 105 Fremont CA 94539-5800 | |
| (510) 656-7424 | |
| (510) 226-7424 |
| Full Name | Neelagiri Dental Group Inc |
|---|---|
| Speciality | Clinic/Center |
| Location | 43625 Mission Blvd Ste 105, Fremont, California |
| Authorized Official Name and Position | Krishna Neelagiri (PRESIDENT) |
| Authorized Official Contact | 4088025270 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Neelagiri Dental Group Inc 6011 Milano Ter Fremont CA 94555-1853 Ph: (510) 402-4432 | Neelagiri Dental Group Inc 43625 Mission Blvd Ste 105 Fremont CA 94539-5800 Ph: (510) 656-7424 |
| NPI Number | 1801550322 |
|---|---|
| Provider Enumeration Date | 10/30/2021 |
| Last Update Date | 10/30/2021 |
| Medicare PECOS PAC ID | 2961872965 |
|---|---|
| Medicare Enrollment ID | O20230109002413 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1801550322 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | (* (Not Available)) | Primary |
| Provider Name | Hak Kyun Kim |
|---|---|
| Provider Type | Practitioner - Dentist |
| Provider Identifiers | NPI Number: 1821583048 PECOS PAC ID: 4789078585 Enrollment ID: I20220221001399 |
| Provider Name | Krishna Neelagiri |
|---|---|
| Provider Type | Practitioner - Dentist |
| Provider Identifiers | NPI Number: 1689952376 PECOS PAC ID: 9830562420 Enrollment ID: I20230321002390 |
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