Healthcare Provider Details

I. General information

NPI: 1639269087
Provider Name (Legal Business Name): SUCHDEEP SINGH BAINS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/14/2006
Last Update Date: 06/02/2021
Certification Date: 06/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2800 L ST STE 600
SACRAMENTO CA
95816-5616
US

IV. Provider business mailing address

PO BOX 255228
SACRAMENTO CA
95865-5228
US

V. Phone/Fax

Practice location:
  • Phone: 916-454-6850
  • Fax:
Mailing address:
  • Phone: 916-708-8038
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD2005-0043
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberA67856
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: