Healthcare Provider Details

I. General information

NPI: 1093074429
Provider Name (Legal Business Name): GAGAN DEEP SINGH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/04/2012
Last Update Date: 04/17/2026
Certification Date: 04/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2803 EL CAMINO REAL
SANTA CLARA CA
95051-2901
US

IV. Provider business mailing address

2803 EL CAMINO REAL
SANTA CLARA CA
95051-2901
US

V. Phone/Fax

Practice location:
  • Phone: 408-540-3166
  • Fax:
Mailing address:
  • Phone: 408-540-3166
  • Fax: 408-409-2553

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberA142133
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: