Provider Demographics
NPI:1578735601
Name:GOPAL RAM SINGH
Entity Type:Organization
Organization Name:GOPAL RAM SINGH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:GOPAL
Authorized Official - Middle Name:RAM
Authorized Official - Last Name:SINGH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:626-854-6540
Mailing Address - Street 1:18856 AMAR RD STE 15
Mailing Address - Street 2:
Mailing Address - City:WALNUT
Mailing Address - State:CA
Mailing Address - Zip Code:91789-7104
Mailing Address - Country:US
Mailing Address - Phone:626-854-6540
Mailing Address - Fax:626-854-6541
Practice Address - Street 1:18856 AMAR RD STE 15
Practice Address - Street 2:
Practice Address - City:WALNUT
Practice Address - State:CA
Practice Address - Zip Code:91789-7104
Practice Address - Country:US
Practice Address - Phone:626-854-6540
Practice Address - Fax:626-854-6541
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GOPAL RAM SINGH
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-03-28
Last Update Date:2008-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA294691223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAB29469-01Medicaid