Healthcare Provider Details

I. General information

NPI: 1023504495
Provider Name (Legal Business Name): JASPREET SINGH KHAIRA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/09/2018
Last Update Date: 07/09/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 MERCED ST
SAN LEANDRO CA
94577-4201
US

IV. Provider business mailing address

34515 EGERTON PL
FREMONT CA
94555-3365
US

V. Phone/Fax

Practice location:
  • Phone: 510-454-1000
  • Fax:
Mailing address:
  • Phone: 510-378-5220
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P2201X
TaxonomyAmbulatory Care Pharmacist
License Number76708
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: