Basic Information
| Provider Information | |||||||||
| NPI: | 1851761472 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | BALJINDER SINGH SIDHU MD INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9570 E SOUTH AVE | ||||||||
| Address2: | |||||||||
| City: | SELMA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 936629768 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 9570 E SOUTH AVE | ||||||||
| Address2: | |||||||||
| City: | SELMA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 936629768 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5592602600 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/26/2015 | ||||||||
| LastUpdateDate: | 09/26/2015 | ||||||||
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| AuthorizedOfficialLastName: | SIDHU | ||||||||
| AuthorizedOfficialFirstName: | BALJINDER | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 5592602600 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | A105992 | CA | N | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | 207RP1001X | A105992 | CA | N | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Pulmonary Disease | 207RS0012X | A105992 | CA | N | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Sleep Medicine | 207RC0200X | A105992 | CA | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Critical Care Medicine |
No ID Information.