Provider Demographics
NPI:1922397645
Name:PATEL, CHIRAG MADHUSUDAN (DMD, MD)
Entity type:Individual
Prefix:DR
First Name:CHIRAG
Middle Name:MADHUSUDAN
Last Name:PATEL
Suffix:
Gender:M
Credentials:DMD, MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4545 MATTOS DR
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94536-6736
Mailing Address - Country:US
Mailing Address - Phone:510-792-9405
Mailing Address - Fax:510-792-0212
Practice Address - Street 1:4545 MATTOS DR
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94536-6736
Practice Address - Country:US
Practice Address - Phone:510-792-9405
Practice Address - Fax:415-792-0212
Is Sole Proprietor?:No
Enumeration Date:2011-04-04
Last Update Date:2025-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA122633204E00000X
CA603341223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
No204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial Surgery