Provider Demographics
NPI:1093893091
Name:CHAHAL, PREMJIT S (MD)
Entity Type:Individual
Prefix:DR
First Name:PREMJIT
Middle Name:S
Last Name:CHAHAL
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 1:400 TAYLOR BLVD.
Mailing Address - Street 2:#304
Mailing Address - City:PLEASANT HILL
Mailing Address - State:CA
Mailing Address - Zip Code:94523
Mailing Address - Country:US
Mailing Address - Phone:925-363-0069
Mailing Address - Fax:925-363-0077
Practice Address - Street 1:400 TAYLOR BLVD.
Practice Address - Street 2:#304
Practice Address - City:PLEASANT HILL
Practice Address - State:CA
Practice Address - Zip Code:94523
Practice Address - Country:US
Practice Address - Phone:925-363-0069
Practice Address - Fax:925-363-0077
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2012-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA78375174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A783753Medicare PIN