Healthcare Provider Details

I. General information

NPI: 1336765619
Provider Name (Legal Business Name): RANDHAWA MEDICAL DOCTORS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/22/2020
Last Update Date: 10/06/2021
Certification Date: 10/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 E 28TH ST STE 419
LONG BEACH CA
90806-2775
US

IV. Provider business mailing address

2801 ATLANTIC AVE
LONG BEACH CA
90806-1701
US

V. Phone/Fax

Practice location:
  • Phone: 562-490-9900
  • Fax:
Mailing address:
  • Phone: 562-951-5110
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code2080P0201X
TaxonomyPediatric Allergy/Immunology Physician
License Number
License Number State

VIII. Authorized Official

Name: CHRISTOPHER CLAY
Title or Position: OPERATIONS MANAGER
Credential:
Phone: 562-490-9900