Healthcare Provider Details

I. General information

NPI: 1962929190
Provider Name (Legal Business Name): JAGDEEP TULI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/28/2017
Last Update Date: 12/11/2020
Certification Date: 12/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2610 TUOLUMNE ST
FRESNO CA
93721-1227
US

IV. Provider business mailing address

7525 N WILLOW AVE APT 221
FRESNO CA
93720-0367
US

V. Phone/Fax

Practice location:
  • Phone: 559-825-2630
  • Fax:
Mailing address:
  • Phone: 917-294-1384
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number57.245117
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: