Healthcare Provider Details

I. General information

NPI: 1043395064
Provider Name (Legal Business Name): RANDHAWA MEDICAL GROUP, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/26/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1349 MAIN ST
NEWMAN CA
95360-1326
US

IV. Provider business mailing address

1349 MAIN ST
NEWMAN CA
95360-1326
US

V. Phone/Fax

Practice location:
  • Phone: 209-862-3604
  • Fax: 209-862-3904
Mailing address:
  • Phone: 209-862-3604
  • Fax: 209-862-3904

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number StateCA

VIII. Authorized Official

Name: TRIPJEET BIRRING
Title or Position: CEO
Credential: FNP
Phone: 209-862-3604