Provider Demographics
NPI:1003956061
Name:HARMOHINDER S ATHWAL INC.
Entity Type:Organization
Organization Name:HARMOHINDER S ATHWAL INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:HARMOHINDER
Authorized Official - Middle Name:SINGH
Authorized Official - Last Name:ATHWAL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:510-651-5808
Mailing Address - Street 1:39885 PASEO PADRE PKWY
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94538-2974
Mailing Address - Country:US
Mailing Address - Phone:510-651-5808
Mailing Address - Fax:510-651-5803
Practice Address - Street 1:39001 SUNDALE DR
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94538-2005
Practice Address - Country:US
Practice Address - Phone:510-574-4860
Practice Address - Fax:510-651-5803
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA81841251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAI11056Medicare UPIN