Provider Demographics
NPI:1801062260
Name:SANTOKH BHULLAR MD INC
Entity type:Organization
Organization Name:SANTOKH BHULLAR MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SANTOKH
Authorized Official - Middle Name:S
Authorized Official - Last Name:BHULLAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:209-834-1844
Mailing Address - Street 1:2231 N TRACY BLVD
Mailing Address - Street 2:SUITE B
Mailing Address - City:TRACY
Mailing Address - State:CA
Mailing Address - Zip Code:95376-2425
Mailing Address - Country:US
Mailing Address - Phone:209-834-1844
Mailing Address - Fax:510-225-0369
Practice Address - Street 1:2231 N TRACY BLVD
Practice Address - Street 2:SUITE B
Practice Address - City:TRACY
Practice Address - State:CA
Practice Address - Zip Code:95376-2425
Practice Address - Country:US
Practice Address - Phone:209-834-1844
Practice Address - Fax:510-225-0369
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-06
Last Update Date:2010-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA61798207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG63192Medicare UPIN
CA00A617980Medicare PIN