Healthcare Provider Details

I. General information

NPI: 1982409371
Provider Name (Legal Business Name): SIMRAN SINGH BANGA DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/18/2025
Last Update Date: 02/18/2025
Certification Date: 02/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

NAVAL MEDICAL CENTER SAN DIEGO 34800 BOB WILSON DRIVE
SAN DIEGO CA
92134-0001
US

IV. Provider business mailing address

NAVAL MEDICAL CENTER SAN DIEGO 34800 BOB WILSON DRIVE
SAN DIEGO CA
92134-0001
US

V. Phone/Fax

Practice location:
  • Phone: 916-439-6999
  • Fax:
Mailing address:
  • Phone: 916-439-6999
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171000000X
TaxonomyMilitary Health Care Provider
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: