Basic Information
Provider Information
NPI: 1508300864
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: SINGH
FirstName: TEJ
MiddleName: KANWAR
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 5400 DOLFIELD AVE
Address2:  
City: BAKERSFIELD
State: CA
PostalCode: 933047051
CountryCode: US
TelephoneNumber:  
FaxNumber:  
Practice Location
Address1: 1600 E BELLE TER
Address2:  
City: BAKERSFIELD
State: CA
PostalCode: 933073871
CountryCode: US
TelephoneNumber: 6616352950
FaxNumber:  
Other Information
ProviderEnumerationDate: 12/06/2016
LastUpdateDate: 12/09/2016
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
171M00000X  Y Other Service ProvidersCase Manager/Care Coordinator 

No ID Information.


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