Provider Demographics
NPI:1306046123
Name:BHAGAT, BIPINCHANDRA VENILAL (MD)
Entity Type:Individual
Prefix:DR
First Name:BIPINCHANDRA
Middle Name:VENILAL
Last Name:BHAGAT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:BIPINCHANDRA
Other - Middle Name:V
Other - Last Name:BHAGAT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:17290 JASMINE ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:VICTORVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:92395-7709
Mailing Address - Country:US
Mailing Address - Phone:760-951-2400
Mailing Address - Fax:760-951-3301
Practice Address - Street 1:17290 JASMINE ST
Practice Address - Street 2:SUITE 101
Practice Address - City:VICTORVILLE
Practice Address - State:CA
Practice Address - Zip Code:92395-7709
Practice Address - Country:US
Practice Address - Phone:760-951-2400
Practice Address - Fax:760-951-3301
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-19
Last Update Date:2021-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA55207174400000X
CAA055207207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Single Specialty
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A552070Medicaid
CA00A552070Medicare PIN
CAG21504Medicare UPIN