Healthcare Provider Details

I. General information

NPI: 1740203736
Provider Name (Legal Business Name): KANWAL J SINGH MD FACC INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/25/2006
Last Update Date: 09/14/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1290 E ALMOND AVE
MADERA CA
93637-5606
US

IV. Provider business mailing address

1290 E ALMOND AVE
MADERA CA
93637
US

V. Phone/Fax

Practice location:
  • Phone: 559-661-6212
  • Fax: 559-661-6216
Mailing address:
  • Phone: 559-661-6212
  • Fax: 559-661-6216

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberA46659
License Number StateCA

VIII. Authorized Official

Name: MRS. MEGAN PHILLIPS
Title or Position: BILLER
Credential:
Phone: 559-661-6212