Provider Demographics
NPI:1598834517
Name:BHATIA, KAWALJEET K (MD)
Entity Type:Individual
Prefix:
First Name:KAWALJEET
Middle Name:K
Last Name:BHATIA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7888 WREN AVE STE C137
Mailing Address - Street 2:
Mailing Address - City:GILROY
Mailing Address - State:CA
Mailing Address - Zip Code:95020-4965
Mailing Address - Country:US
Mailing Address - Phone:408-848-5522
Mailing Address - Fax:408-848-2369
Practice Address - Street 1:624 EAST 10TH ST
Practice Address - Street 2:SUITE E PMB 624
Practice Address - City:GILROY
Practice Address - State:CA
Practice Address - Zip Code:95020
Practice Address - Country:US
Practice Address - Phone:408-848-5522
Practice Address - Fax:408-848-2369
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA420502080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A420500Medicaid