Healthcare Provider Details

I. General information

NPI: 1871155259
Provider Name (Legal Business Name): GAGANDEEPSINGH&TIMONTHYJOHNSTON
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/05/2019
Last Update Date: 07/05/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

650 W OLIVE AVE
MERCED CA
95348-2423
US

IV. Provider business mailing address

836 ROUND HILL DR
MERCED CA
95348-8422
US

V. Phone/Fax

Practice location:
  • Phone: 718-964-3919
  • Fax:
Mailing address:
  • Phone: 718-964-3919
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207QA0000X
TaxonomyAdolescent Medicine (Family Medicine) Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code207QH0002X
TaxonomyHospice and Palliative Medicine (Family Medicine) Physician
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: MRS. HARSIMRAT KAUR BAINS
Title or Position: OFFICE MANAGER,RN
Credential:
Phone: 718-964-3919