Provider Demographics
NPI:1083611594
Name:BAJWA, RANDEEP SINGH (MD)
Entity Type:Individual
Prefix:
First Name:RANDEEP
Middle Name:SINGH
Last Name:BAJWA
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 1:1805 N CALIFORNIA ST
Mailing Address - Street 2:STE 303
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95204-6033
Mailing Address - Country:US
Mailing Address - Phone:209-943-0851
Mailing Address - Fax:209-943-0137
Practice Address - Street 1:1805 N CALIFORNIA ST
Practice Address - Street 2:STE 303
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95204-6033
Practice Address - Country:US
Practice Address - Phone:209-888-4340
Practice Address - Fax:209-888-4371
Is Sole Proprietor?:No
Enumeration Date:2005-06-30
Last Update Date:2023-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA104576207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ216932Medicaid
OH2483987Medicaid
AZ115517Medicare UPIN
AZ216932Medicaid
I07453Medicare UPIN