Healthcare Provider Details

I. General information

NPI: 1306000922
Provider Name (Legal Business Name): JASWINDER PAL SINGH BAJWA M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/13/2008
Last Update Date: 08/20/2021
Certification Date: 08/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6608 MERCY CT STE B
FAIR OAKS CA
95628-3171
US

IV. Provider business mailing address

6608 MERCY CT STE B
FAIR OAKS CA
95628-3171
US

V. Phone/Fax

Practice location:
  • Phone: 619-432-2592
  • Fax:
Mailing address:
  • Phone: 619-432-2592
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA118049
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberMD443751
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberA118049
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: