Healthcare Provider Details

I. General information

NPI: 1609970870
Provider Name (Legal Business Name): TEJINDER S RANDHAWA MD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/11/2006
Last Update Date: 03/09/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5043 E KINGS CANYON RD STE 101
FRESNO CA
93727-3962
US

IV. Provider business mailing address

PO BOX 25578
FRESNO CA
93729-5578
US

V. Phone/Fax

Practice location:
  • Phone: 559-455-1500
  • Fax: 559-253-1302
Mailing address:
  • Phone: 559-455-1500
  • Fax: 559-253-1302

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA53378
License Number StateCA

VIII. Authorized Official

Name: DR. TEJINDER SINGH RANDHAWA
Title or Position: PHYSICIAN/OWNER
Credential: MD
Phone: 559-455-1500