Provider Demographics
NPI:1003879743
Name:BHALLA, JAGMINDER SINGH (MD)
Entity Type:Individual
Prefix:DR
First Name:JAGMINDER
Middle Name:SINGH
Last Name:BHALLA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1781 W ROMNEYA DR
Mailing Address - Street 2:STE C
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92801-1818
Mailing Address - Country:US
Mailing Address - Phone:714-956-3160
Mailing Address - Fax:714-956-1188
Practice Address - Street 1:1781 W ROMNEYA DR
Practice Address - Street 2:STE C
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92801-1818
Practice Address - Country:US
Practice Address - Phone:714-956-3160
Practice Address - Fax:714-956-1188
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-11
Last Update Date:2019-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA25813207RC0200X, 207RP1001X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0021080Medicaid
CACM972AOtherMEDICARE ID
CAA24581Medicare UPIN