Provider Demographics
NPI:1326159831
Name:KHALSA, MANINDER (MD)
Entity Type:Individual
Prefix:DR
First Name:MANINDER
Middle Name:
Last Name:KHALSA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10470 OLD PLACERVILLE RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95827-2539
Mailing Address - Country:US
Mailing Address - Phone:800-470-0071
Mailing Address - Fax:
Practice Address - Street 1:2700 GATEWAY OAKS DR
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95833-4337
Practice Address - Country:US
Practice Address - Phone:916-781-1927
Practice Address - Fax:916-781-1787
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2016-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA88377207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A883770OtherBLUE SHIELD
CA2238104OtherFIRST HEALTH
CA237357OtherINTERPLAN
CA2688953OtherUNITED HEALTHCARE
CA7266622OtherAETNA
CA1855774OtherGREAT WEST
CA00A883770Medicaid
CAA88377OtherBLUE CROSS
CA90143526OtherPACIFICARE
CA000810615089OtherPHCS
CAMCMG359000OtherWESTERN HEALTH ADVANTAGE
CA106604OtherHEALTH NET
CA5377591OtherCIGNA
CA5377591OtherCIGNA
CAA88377OtherBLUE CROSS
CA7266622OtherAETNA