Provider Demographics
NPI:1962563122
Name:MADAN, SONU (DDS)
Entity type:Individual
Prefix:DR
First Name:SONU
Middle Name:
Last Name:MADAN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1235 WILDWOOD AVE APT 384
Mailing Address - Street 2:
Mailing Address - City:SUNNYVALE
Mailing Address - State:CA
Mailing Address - Zip Code:94089-2726
Mailing Address - Country:US
Mailing Address - Phone:408-454-6176
Mailing Address - Fax:
Practice Address - Street 1:1871 CAMDEN AVE
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95124-2945
Practice Address - Country:US
Practice Address - Phone:408-377-5700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA50952122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist