Provider Demographics
NPI:1609970870
Name:TEJINDER S RANDHAWA MD INC
Entity Type:Organization
Organization Name:TEJINDER S RANDHAWA MD INC
Other - Org Name:CHILDRENS MEDICAL CENTERS OF FRESNO
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TEJINDER
Authorized Official - Middle Name:SINGH
Authorized Official - Last Name:RANDHAWA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:559-455-1500
Mailing Address - Street 1:PO BOX 25578
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93729-5578
Mailing Address - Country:US
Mailing Address - Phone:559-455-1500
Mailing Address - Fax:559-253-1302
Practice Address - Street 1:5043 E KINGS CANYON RD STE 101
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93727-3962
Practice Address - Country:US
Practice Address - Phone:559-455-1500
Practice Address - Fax:559-253-1302
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-11
Last Update Date:2011-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA53378208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA53378OtherMEDICAL LICENSE
CAGR0104701Medicaid