Healthcare Provider Details

I. General information

NPI: 1003826298
Provider Name (Legal Business Name): JAGJEET S. KALRA MD INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/09/2006
Last Update Date: 11/19/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

530 W EATON AVE SUITE E
TRACY CA
95376-3400
US

IV. Provider business mailing address

530 W EATON AVE SUITE E
TRACY CA
95376-3400
US

V. Phone/Fax

Practice location:
  • Phone: 209-830-1500
  • Fax: 209-833-2496
Mailing address:
  • Phone: 209-830-1500
  • Fax: 209-833-2496

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License NumberA44804
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207RS0012X
TaxonomySleep Medicine (Internal Medicine) Physician
License NumberA44804
License Number StateCA

VIII. Authorized Official

Name: DR. JAGJEET SINGH KALRA
Title or Position: PRESIDENT
Credential: MD
Phone: 209-830-1500