Healthcare Provider Details

I. General information

NPI: 1548353170
Provider Name (Legal Business Name): INDERJEET SINGH JULKA MD A MEDICAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 02/20/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16543 CARMENTIA AVENUE
CERRITOS CA
90703-2218
US

IV. Provider business mailing address

210 N TUSTIN AVE
SANTA ANA CA
92705
US

V. Phone/Fax

Practice location:
  • Phone: 562-219-7251
  • Fax:
Mailing address:
  • Phone: 800-883-7243
  • Fax: 714-647-1245

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberA77561
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License NumberA77561
License Number StateCA

VIII. Authorized Official

Name: DR. INDERJEET S JULKA
Title or Position: PRESIDENT
Credential: M.D.
Phone: 800-883-7243