Healthcare Provider Details

I. General information

NPI: 1063493328
Provider Name (Legal Business Name): DALJEET SINGH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/14/2005
Last Update Date: 12/08/2021
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 MAREBLU 100
ALISO VIEJO CA
92656-3015
US

IV. Provider business mailing address

2742 DOW AVE
TUSTIN CA
92780-7242
US

V. Phone/Fax

Practice location:
  • Phone: 949-448-0656
  • Fax: 949-425-2465
Mailing address:
  • Phone: 714-665-1600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA76612
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: