Provider Demographics
NPI:1043390040
Name:BAJWA, SAIF U (MD)
Entity Type:Individual
Prefix:
First Name:SAIF
Middle Name:U
Last Name:BAJWA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:31739 RIVERSIDE DR
Mailing Address - Street 2:# A
Mailing Address - City:LAKE ELSINORE
Mailing Address - State:CA
Mailing Address - Zip Code:92530-7818
Mailing Address - Country:US
Mailing Address - Phone:951-674-2155
Mailing Address - Fax:951-674-9788
Practice Address - Street 1:31739 RIVERSIDE DR
Practice Address - Street 2:# A
Practice Address - City:LAKE ELSINORE
Practice Address - State:CA
Practice Address - Zip Code:92530-7818
Practice Address - Country:US
Practice Address - Phone:951-674-2155
Practice Address - Fax:951-674-9788
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-16
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA066948207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A669480Medicaid
CA00A669480Medicare ID - Type Unspecified
CA00A669480Medicaid