Healthcare Provider Details

I. General information

NPI: 1093852659
Provider Name (Legal Business Name): PREM D. SINGH, M.D. & ASSOC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/31/2007
Last Update Date: 01/16/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2210 E ILLINOIS AVE SUITE 206
FRESNO CA
93701-2125
US

IV. Provider business mailing address

2210 E. ILLINOIS SUITE 206
FRESNO CA
93701-2166
US

V. Phone/Fax

Practice location:
  • Phone: 559-264-2504
  • Fax: 559-264-3707
Mailing address:
  • Phone: 559-264-2504
  • Fax: 559-264-3707

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. PREM DEEP SINGH
Title or Position: OWNER
Credential: M.D.
Phone: 559-264-2504