Healthcare Provider Details

I. General information

NPI: 1891131702
Provider Name (Legal Business Name): SUMIT BAGGA M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/18/2013
Last Update Date: 12/07/2021
Certification Date: 12/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15301 WARREN SHINGLE RD 9TH MEDICAL GROUP
BEALE AFB CA
95903-1907
US

IV. Provider business mailing address

15301 WARREN SHINGLE RD 9TH MEDICAL GROUP
BEALE AFB CA
95903-1907
US

V. Phone/Fax

Practice location:
  • Phone: 530-634-4750
  • Fax:
Mailing address:
  • Phone: 530-634-4750
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number125062362
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: