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General NPI Number Information
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NPI Number | 1922297209
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Entity Type | Organization
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Legal Business Name | JASDEEP S BAL MD A PROFESSIONAL MEDICAL CORPORATION
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Dates
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Enumeration Date | 10/23/2007
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Last Update Date | 03/19/2014
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Provider Practice Location Address
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Address Line | 3385 BORDEAUX DR
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City | EL DORADO HILLS
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State | CA
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Zip | 95762-3984
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Country | US
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Telephone | 916-835-5396
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Fax |
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Provider Business Mailing Address
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Address Line | 3385 BORDEAUX DR
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City | EL DORADO HILLS
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State | CA
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Zip | 95762-3984
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Country | US
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Telephone | 916-835-5396
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JASDEEP S BAL
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Credential | MD
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Telephone | 916-835-5396
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 00A812395
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License Number State | CA
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