Provider Demographics
NPI:1447314828
Name:BAHUGUNA, CHARU (NP)
Entity type:Individual
Prefix:MRS
First Name:CHARU
Middle Name:
Last Name:BAHUGUNA
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:825 FIGWOOD CT
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95120-3313
Mailing Address - Country:US
Mailing Address - Phone:408-972-7647
Mailing Address - Fax:408-972-3411
Practice Address - Street 1:280 HOSPITAL PKWY
Practice Address - Street 2:SUITE C
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95119-1103
Practice Address - Country:US
Practice Address - Phone:408-972-7647
Practice Address - Fax:408-972-3455
Is Sole Proprietor?:No
Enumeration Date:2006-12-20
Last Update Date:2022-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA455409 AND 9934363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAQ16794Medicare UPIN