Basic Information
| Provider Information | |||||||||
| NPI: | 1598965667 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | CHANDAN DS CHEEMA MD INC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | CAPITAL MEDICAL EXTENDED CARE | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6608 MERCY CT STE B | ||||||||
| Address2: | |||||||||
| City: | FAIR OAKS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 956283171 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9162419844 | ||||||||
| FaxNumber: | 9162419845 | ||||||||
| Practice Location | |||||||||
| Address1: | 6608 MERCY CT STE B | ||||||||
| Address2: | |||||||||
| City: | FAIR OAKS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 956283171 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9162419844 | ||||||||
| FaxNumber: | 9162419845 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/18/2007 | ||||||||
| LastUpdateDate: | 04/12/2021 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | CHEEMA | ||||||||
| AuthorizedOfficialFirstName: | CHANDAN | ||||||||
| AuthorizedOfficialMiddleName: | DEEP SINGH | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 9162419844 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | DR. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | MD | ||||||||
| NPICertificationDate: | 04/12/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RG0300X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Geriatric Medicine | 207R00000X | 00A47747 | CA | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | ZZZ05271Z | 01 | CA | GROUP PTAN | OTHER |