Provider Demographics
NPI:1043205594
Name:MANJAL, SUKHBIR (MD)
Entity Type:Individual
Prefix:
First Name:SUKHBIR
Middle Name:
Last Name:MANJAL
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:PO BOX 28949
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93729-8949
Mailing Address - Country:US
Mailing Address - Phone:559-228-4200
Mailing Address - Fax:559-224-3920
Practice Address - Street 1:6725 N WILLOW AVE STE 106
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93710-5951
Practice Address - Country:US
Practice Address - Phone:559-494-4014
Practice Address - Fax:559-494-4015
Is Sole Proprietor?:No
Enumeration Date:2005-09-12
Last Update Date:2024-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA69930207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A699300Medicaid
CA00A699300Medicaid
CA00A699300Medicare PIN
CA00A699304Medicare PIN
CAH41031Medicare UPIN