MEDICARE: PACIFIC KIDNEY & HYPERTENSION INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RN0300X	Nephrology Physician	A104576	CA

General Provider Information

NPI Number	:	1972819803
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PACIFIC KIDNEY & HYPERTENSION INC

Provider Business Mailing Address
First Line	:	2350 N CALIFORNIA ST
Second Line	:
City	:	STOCKTON
State	:	CA
Zip	:	95204-5506
Country	:	US
Telephone Number	:	209-943-0851
Fax Number	:	209-943-0137

Provider Business Practice Location Address
First Line	:	1805 N CALIFORNIA ST STE 303
Second Line	:
City	:	STOCKTON
State	:	CA
Zip	:	95204-6033
Country	:	US
Telephone Number	:	209-888-4340
Fax Number	:	209-888-4371

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. RANDEEP BAJWA
Credential	:	MD
Telephone Number	:	209-943-0851

Provider Enumeration Date	:	08/30/2010
Last Update Date	:	08/07/2023

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