Provider Demographics
NPI:1235411349
Name:OPERATION BLUE STAR
Entity Type:Organization
Organization Name:OPERATION BLUE STAR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:HARDEEP
Authorized Official - Middle Name:SINGH
Authorized Official - Last Name:AHULWALIA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:650-450-0776
Mailing Address - Street 1:PO BOX 659
Mailing Address - Street 2:
Mailing Address - City:LOS ALTOS
Mailing Address - State:CA
Mailing Address - Zip Code:94023-0659
Mailing Address - Country:US
Mailing Address - Phone:650-268-8360
Mailing Address - Fax:
Practice Address - Street 1:658 FREMONT AVE
Practice Address - Street 2:
Practice Address - City:LOS ALTOS
Practice Address - State:CA
Practice Address - Zip Code:94023-0659
Practice Address - Country:US
Practice Address - Phone:650-268-8360
Practice Address - Fax:650-209-5911
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-14
Last Update Date:2014-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA86707174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1780885574OtherNPI