Healthcare Provider Details

I. General information

NPI: 1598965667
Provider Name (Legal Business Name): CHANDAN DS CHEEMA MD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/18/2007
Last Update Date: 04/12/2021
Certification Date: 04/12/2021
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: 916-241-9844
  • Fax: 916-241-9845
Mailing address:
  • Phone: 916-241-9844
  • Fax: 916-241-9845

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number00A47747
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. CHANDAN DEEP SINGH CHEEMA
Title or Position: PRESIDENT
Credential: MD
Phone: 916-241-9844