Provider Demographics
NPI:1114052743
Name:MOHINDER SINGH POONIA MD PC
Entity Type:Organization
Organization Name:MOHINDER SINGH POONIA MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SHARE HOLDER
Authorized Official - Prefix:
Authorized Official - First Name:MOHINDER
Authorized Official - Middle Name:SINGH
Authorized Official - Last Name:POONIA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:559-325-2000
Mailing Address - Street 1:7035 N CHESTNUT AVE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93720-0352
Mailing Address - Country:US
Mailing Address - Phone:559-325-2000
Mailing Address - Fax:559-325-2021
Practice Address - Street 1:7035 N CHESTNUT AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93720-0352
Practice Address - Country:US
Practice Address - Phone:559-325-2000
Practice Address - Fax:559-325-2021
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-23
Last Update Date:2011-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA36683207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ23492ZMedicare PIN