Healthcare Provider Details

I. General information

NPI: 1972814069
Provider Name (Legal Business Name): AMANDEEP BHALLA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2010
Last Update Date: 07/20/2026
Certification Date: 07/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3610 LONG BEACH BLVD STE 202
LONG BEACH CA
90807-4091
US

IV. Provider business mailing address

3610 LONG BEACH BLVD SUITE 202
LONG BEACH CA
90807
US

V. Phone/Fax

Practice location:
  • Phone: 562-427-8119
  • Fax: 562-546-1227
Mailing address:
  • Phone: 562-427-8119
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number261870
License Number StateMA
# 3
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberA120313
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: