Provider Demographics
NPI:1609920156
Name:MAHAL, SURJIT KAUR (MD)
Entity Type:Individual
Prefix:DR
First Name:SURJIT
Middle Name:KAUR
Last Name:MAHAL
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 1:39225 STATE ST
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94538-1437
Mailing Address - Country:US
Mailing Address - Phone:510-794-3641
Mailing Address - Fax:510-794-1341
Practice Address - Street 1:39225 STATE ST
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94538-1437
Practice Address - Country:US
Practice Address - Phone:510-794-3641
Practice Address - Fax:510-794-1341
Is Sole Proprietor?:No
Enumeration Date:2007-01-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA033050207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA033050OtherLICENCE #
A87790Medicare UPIN