Provider Demographics
NPI:1134305675
Name:RANDHAWA, JASLEEN KAUR (MD)
Entity Type:Individual
Prefix:
First Name:JASLEEN
Middle Name:KAUR
Last Name:RANDHAWA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6445 MAIN STREET
Mailing Address - Street 2:OPC24
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030
Mailing Address - Country:US
Mailing Address - Phone:713-441-9948
Mailing Address - Fax:713-790-6470
Practice Address - Street 1:6445 MAIN STREET
Practice Address - Street 2:OPC24
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030
Practice Address - Country:US
Practice Address - Phone:713-441-9948
Practice Address - Fax:713-790-6470
Is Sole Proprietor?:No
Enumeration Date:2008-01-15
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI53851207RH0003X, 208M00000X
TXR2206207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX371908001Medicaid