Provider Demographics
NPI:1043395064
Name:RANDHAWA MEDICAL GROUP, INC.
Entity Type:Organization
Organization Name:RANDHAWA MEDICAL GROUP, INC.
Other - Org Name:NEWMAN MEDICAL CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:TRIPJEET
Authorized Official - Middle Name:
Authorized Official - Last Name:BIRRING
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:209-862-3604
Mailing Address - Street 1:1349 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:NEWMAN
Mailing Address - State:CA
Mailing Address - Zip Code:95360-1326
Mailing Address - Country:US
Mailing Address - Phone:209-862-3604
Mailing Address - Fax:209-862-3904
Practice Address - Street 1:1349 MAIN ST
Practice Address - Street 2:
Practice Address - City:NEWMAN
Practice Address - State:CA
Practice Address - Zip Code:95360-1326
Practice Address - Country:US
Practice Address - Phone:209-862-3604
Practice Address - Fax:209-862-3904
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-26
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0094360Medicaid
CAGR0094360Medicaid