Basic Information
| Provider Information | |||||||||
| NPI: | 1154401792 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BHOWN | ||||||||
| FirstName: | NIVEDITA | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1422 EL CAMINO REAL | ||||||||
| Address2: | |||||||||
| City: | MENLO PARK | ||||||||
| State: | CA | ||||||||
| PostalCode: | 940254110 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6509039500 | ||||||||
| FaxNumber: | 6509039900 | ||||||||
| Practice Location | |||||||||
| Address1: | 1422 EL CAMINO REAL | ||||||||
| Address2: | |||||||||
| City: | MENLO PARK | ||||||||
| State: | CA | ||||||||
| PostalCode: | 940254110 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6509039500 | ||||||||
| FaxNumber: | 6509039900 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/17/2006 | ||||||||
| LastUpdateDate: | 03/22/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | A56156 | CA | Y | Allopathic & Osteopathic Physicians | Anesthesiology |
ID Information
| ID | Type | State | Issuer | Description | 00A561560 | 05 | CA | MEDICAID |