Provider Demographics
NPI:1467562249
Name:TAKHAR, DALJINDER (DO)
Entity Type:Individual
Prefix:MR
First Name:DALJINDER
Middle Name:
Last Name:TAKHAR
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:160 E ARTESIA ST
Mailing Address - Street 2:SUITE 225
Mailing Address - City:POMONA
Mailing Address - State:CA
Mailing Address - Zip Code:91767-2900
Mailing Address - Country:US
Mailing Address - Phone:909-629-7878
Mailing Address - Fax:909-629-2850
Practice Address - Street 1:160 E ARTESIA ST
Practice Address - Street 2:SUITE 225
Practice Address - City:POMONA
Practice Address - State:CA
Practice Address - Zip Code:91767-2900
Practice Address - Country:US
Practice Address - Phone:909-629-7878
Practice Address - Fax:909-629-2850
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2015-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A7322207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAP00021615OtherRAILROAD
CA00AX73220Medicaid
CA00AX73220N31OtherCOL OPTIMA
CA020A73222Medicare ID - Type Unspecified
CA00AX73220N31OtherCOL OPTIMA
CAW20A7322CMedicare ID - Type Unspecified