Provider Demographics
NPI:1003826298
Name:JAGJEET S. KALRA MD INC.
Entity type:Organization
Organization Name:JAGJEET S. KALRA MD INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAGJEET
Authorized Official - Middle Name:SINGH
Authorized Official - Last Name:KALRA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:209-830-1500
Mailing Address - Street 1:530 W EATON AVE
Mailing Address - Street 2:SUITE E
Mailing Address - City:TRACY
Mailing Address - State:CA
Mailing Address - Zip Code:95376-3400
Mailing Address - Country:US
Mailing Address - Phone:209-830-1500
Mailing Address - Fax:209-833-2496
Practice Address - Street 1:530 W EATON AVE
Practice Address - Street 2:SUITE E
Practice Address - City:TRACY
Practice Address - State:CA
Practice Address - Zip Code:95376-3400
Practice Address - Country:US
Practice Address - Phone:209-830-1500
Practice Address - Fax:209-833-2496
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:JAGJEET S. KALRA MD INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-08-09
Last Update Date:2009-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA44804207RS0012X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Single Specialty
No207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ05893ZMedicare PIN
CAW19920Medicare PIN