Healthcare Provider Details

I. General information

NPI: 1487633764
Provider Name (Legal Business Name): AJIT SINGH KHAIRA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/13/2006
Last Update Date: 02/28/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3120 TULARE ST #102
FRESNO CA
93721-1443
US

IV. Provider business mailing address

3120 TULARE ST #102
FRESNO CA
93721-1443
US

V. Phone/Fax

Practice location:
  • Phone: 559-233-0933
  • Fax: 559-233-4364
Mailing address:
  • Phone: 559-233-0933
  • Fax: 559-233-4364

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA46411
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: