Provider Demographics
NPI:1689826661
Name:TIWANA, JASBIR SINGH (MD)
Entity Type:Individual
Prefix:DR
First Name:JASBIR
Middle Name:SINGH
Last Name:TIWANA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:JASBIR
Other - Middle Name:
Other - Last Name:SINGH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1172 SWALLOW LN
Mailing Address - Street 2:
Mailing Address - City:SIMI VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:93065-3154
Mailing Address - Country:US
Mailing Address - Phone:805-583-4111
Mailing Address - Fax:805-583-2041
Practice Address - Street 1:1172 SWALLOW LN
Practice Address - Street 2:
Practice Address - City:SIMI VALLEY
Practice Address - State:CA
Practice Address - Zip Code:93065-3154
Practice Address - Country:US
Practice Address - Phone:951-278-5590
Practice Address - Fax:951-272-9924
Is Sole Proprietor?:No
Enumeration Date:2008-10-21
Last Update Date:2023-01-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA105298208M00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1326839Medicaid
1154633527OtherBUISNESS NPI
CA1689826661Medicaid
CADT821AOtherMEDICARE PTAN