Provider Demographics
NPI:1477962645
Name:TANVEER S. BAJWA, MD., INC.
Entity Type:Organization
Organization Name:TANVEER S. BAJWA, MD., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TANVEER
Authorized Official - Middle Name:S
Authorized Official - Last Name:BAJWA
Authorized Official - Suffix:
Authorized Official - Credentials:MD,
Authorized Official - Phone:209-993-7471
Mailing Address - Street 1:5345 N EL DORADO ST
Mailing Address - Street 2:SUITE 3
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95207-5872
Mailing Address - Country:US
Mailing Address - Phone:209-478-4041
Mailing Address - Fax:
Practice Address - Street 1:5345 N EL DORADO ST
Practice Address - Street 2:SUITE 3
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95207-5872
Practice Address - Country:US
Practice Address - Phone:209-478-4041
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-12
Last Update Date:2014-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA129058261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care