=====================================================
General NPI Number Information
=====================================================
NPI Number | 1194889964
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | JAGJEET S. KALRA M.D., INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/19/2006
-----------------------------------------------------
Last Update Date | 12/03/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 530 W EATON AVE SUITE C
-----------------------------------------------------
City | TRACY
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95376-3400
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 209-833-2493
-----------------------------------------------------
Fax | 209-833-2496
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 530 W EATON AVE SUITE C
-----------------------------------------------------
City | TRACY
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95376-3400
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 209-833-2493
-----------------------------------------------------
Fax | 209-833-2496
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. JAGJEET SINGH KALRA
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 209-833-2493
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RP1001X
-----------------------------------------------------
Taxonomy Name | Pulmonary Disease Physician
-----------------------------------------------------
License Number | A44804
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------