Healthcare Provider Details

I. General information

NPI: 1821326810
Provider Name (Legal Business Name): JAGMINDER SINGH BHALLA M.D., INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/02/2009
Last Update Date: 05/21/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1801 W ROMNEYA DR STE. 405
ANAHEIM CA
92801-1830
US

IV. Provider business mailing address

1801 W ROMNEYA DR STE. 405
ANAHEIM CA
92801-1830
US

V. Phone/Fax

Practice location:
  • Phone: 714-956-3160
  • Fax: 714-956-1188
Mailing address:
  • Phone: 714-956-3160
  • Fax: 714-956-1188

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: JAGMINDER SINGH BHALLA
Title or Position: M.D.
Credential: M.D.
Phone: 714-956-3160