Basic Information
Provider Information | |||||||||
NPI: | 1669401386 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | BOPARAI | ||||||||
FirstName: | KULVINDER | ||||||||
MiddleName: | SINGH | ||||||||
NamePrefix: | DR. | ||||||||
NameSuffix: |   | ||||||||
Credential: | M.D. | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 11985 HERITAGE OAK PL | ||||||||
Address2: | STE 100 | ||||||||
City: | AUBURN | ||||||||
State: | CA | ||||||||
PostalCode: | 956032413 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 5308890872 | ||||||||
FaxNumber: | 5308894978 | ||||||||
Practice Location | |||||||||
Address1: | 7777 SUNRISE BLVD STE 2500 | ||||||||
Address2: |   | ||||||||
City: | CITRUS HEIGHTS | ||||||||
State: | CA | ||||||||
PostalCode: | 956102372 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 9166461200 | ||||||||
FaxNumber: | 8778602703 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 07/03/2006 | ||||||||
LastUpdateDate: | 04/08/2022 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 04/08/2022 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | C50051 | CA | Y |   | Allopathic & Osteopathic Physicians | Internal Medicine |   |
ID Information
ID | Type | State | Issuer | Description | P01453378-DV5277 | 01 | CA | RAILROAD MEDICARE | OTHER |