Provider Demographics
NPI:1154633527
Name:JASBIR S. TIWANA M.D INC
Entity Type:Organization
Organization Name:JASBIR S. TIWANA M.D INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:JASBIR
Authorized Official - Middle Name:SINGH
Authorized Official - Last Name:TIWANA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:805-583-4111
Mailing Address - Street 1:2060-D E AVENIDA DE LOS ARBOLES STE 765
Mailing Address - Street 2:
Mailing Address - City:THOUSAND OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91362-1376
Mailing Address - Country:US
Mailing Address - Phone:805-990-0439
Mailing Address - Fax:805-512-7265
Practice Address - Street 1:1172 SWALLOW LN
Practice Address - Street 2:
Practice Address - City:SIMI VALLEY
Practice Address - State:CA
Practice Address - Zip Code:93065-3154
Practice Address - Country:US
Practice Address - Phone:951-278-5590
Practice Address - Fax:951-272-9924
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-13
Last Update Date:2023-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA105298207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADT821AOtherMEDICARE PTAN
CA1326839Medicaid