Provider Demographics
NPI:1164638805
Name:BHULLAR, GURPREET SINGH (OTR)
Entity type:Individual
Prefix:
First Name:GURPREET
Middle Name:SINGH
Last Name:BHULLAR
Suffix:
Gender:M
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4922 HUFFMAN TER
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94555-2646
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1850 ALICE ST
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94612-4175
Practice Address - Country:US
Practice Address - Phone:510-835-5511
Practice Address - Fax:510-893-3212
Is Sole Proprietor?:No
Enumeration Date:2007-05-16
Last Update Date:2009-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA6925174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist