Provider Demographics
NPI:1992090856
Name:DHARMA, KANCHAN HUNDRAJ (DMD)
Entity type:Individual
Prefix:MRS
First Name:KANCHAN
Middle Name:HUNDRAJ
Last Name:DHARMA
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3055 MOWRY AVE
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94538
Mailing Address - Country:US
Mailing Address - Phone:510-494-9010
Mailing Address - Fax:510-494-9868
Practice Address - Street 1:3055 MOWRY AVE
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94538
Practice Address - Country:US
Practice Address - Phone:510-494-9010
Practice Address - Fax:510-494-9868
Is Sole Proprietor?:No
Enumeration Date:2011-06-17
Last Update Date:2014-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA608181223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice