Provider Demographics
NPI:1225340862
Name:BASSRA, JASDEEP SINGH
Entity Type:Individual
Prefix:MR
First Name:JASDEEP
Middle Name:SINGH
Last Name:BASSRA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1929 CEDAR ST
Mailing Address - Street 2:8
Mailing Address - City:FOREST GROVE
Mailing Address - State:OR
Mailing Address - Zip Code:97116-2046
Mailing Address - Country:US
Mailing Address - Phone:503-812-4904
Mailing Address - Fax:
Practice Address - Street 1:1929 CEDAR ST
Practice Address - Street 2:8
Practice Address - City:FOREST GROVE
Practice Address - State:OR
Practice Address - Zip Code:97116-2046
Practice Address - Country:US
Practice Address - Phone:503-812-4904
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-12
Last Update Date:2010-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program