Provider Demographics
NPI:1760594105
Name:BHULLAR, SANTOKH (MD)
Entity Type:Individual
Prefix:DR
First Name:SANTOKH
Middle Name:
Last Name:BHULLAR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2231 N TRACY BLVD
Mailing Address - Street 2:SUITE B
Mailing Address - City:TRACY
Mailing Address - State:CA
Mailing Address - Zip Code:95376-2425
Mailing Address - Country:US
Mailing Address - Phone:510-304-3075
Mailing Address - Fax:510-225-0369
Practice Address - Street 1:1234 E NORTH ST
Practice Address - Street 2:SUITE 201
Practice Address - City:MANTECA
Practice Address - State:CA
Practice Address - Zip Code:95336-4960
Practice Address - Country:US
Practice Address - Phone:510-304-3075
Practice Address - Fax:510-225-0369
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2021-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA061798207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A617980Medicare ID - Type Unspecified
CAG63192Medicare UPIN