Provider Demographics
NPI:1235537739
Name:LONGIA, SIMRANJIT SINGH (MEDICAL STUDENT (3RD)
Entity Type:Individual
Prefix:MR
First Name:SIMRANJIT
Middle Name:SINGH
Last Name:LONGIA
Suffix:
Gender:M
Credentials:MEDICAL STUDENT (3RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 6015
Mailing Address - Street 2:
Mailing Address - City:FEDERAL WAY
Mailing Address - State:WA
Mailing Address - Zip Code:98063
Mailing Address - Country:US
Mailing Address - Phone:253-336-4512
Mailing Address - Fax:253-838-4145
Practice Address - Street 1:34618 11TH AVE. S.
Practice Address - Street 2:SUITE 100
Practice Address - City:FEDERAL WAY
Practice Address - State:WA
Practice Address - Zip Code:98003
Practice Address - Country:US
Practice Address - Phone:253-336-4512
Practice Address - Fax:253-838-4145
Is Sole Proprietor?:No
Enumeration Date:2014-12-15
Last Update Date:2014-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program