Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207R00000X | Internist | A25813 | CA |
Y | 111NI0900X | Internist | A25813 | CA |
N | 207RC0200X | Critical Care Medicine | A25813 | CA |
N | 207RP1001X | Pulmonary Disease | A25813 | CA |
NPI | 1003879743 |
---|---|
Provider Name | Dr. Jagminder Singh Bhalla |
First Address | Anaheim, CA 92801-1818 |
Second Address | Anaheim, CA 92801-1818 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/04/2006 |
Last Update Date | 18/10/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
A24581 | (02) | CA |
CM972A | MEDICARE ID (01) | CA |
GR0021080 | (05) | CA |