Provider Demographics
NPI:1598965667
Name:CHANDAN DS CHEEMA MD INC
Entity Type:Organization
Organization Name:CHANDAN DS CHEEMA MD INC
Other - Org Name:CAPITAL MEDICAL EXTENDED CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHANDAN
Authorized Official - Middle Name:DEEP SINGH
Authorized Official - Last Name:CHEEMA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:916-241-9844
Mailing Address - Street 1:6608 MERCY CT STE B
Mailing Address - Street 2:
Mailing Address - City:FAIR OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:95628-3171
Mailing Address - Country:US
Mailing Address - Phone:916-241-9844
Mailing Address - Fax:916-241-9845
Practice Address - Street 1:6608 MERCY CT STE B
Practice Address - Street 2:
Practice Address - City:FAIR OAKS
Practice Address - State:CA
Practice Address - Zip Code:95628-3171
Practice Address - Country:US
Practice Address - Phone:916-241-9844
Practice Address - Fax:916-241-9845
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-18
Last Update Date:2021-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA00A47747207R00000X
207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ05271ZOtherGROUP PTAN
CA00A477472OtherINDIVIDUAL TPAN