Provider Demographics
NPI:1801864988
Name:KHAIRA, JAGMOHAN SINGH (MD)
Entity Type:Individual
Prefix:DR
First Name:JAGMOHAN
Middle Name:SINGH
Last Name:KHAIRA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:1050 MARINA VILLAGE PKWY
Mailing Address - Street 2:STE 101
Mailing Address - City:ALAMEDA
Mailing Address - State:CA
Mailing Address - Zip Code:94501-1033
Mailing Address - Country:US
Mailing Address - Phone:510-227-5540
Mailing Address - Fax:510-788-6849
Practice Address - Street 1:1050 MARINA VILLAGE PARKWAY
Practice Address - Street 2:SUITE 101
Practice Address - City:ALAMEDA
Practice Address - State:CA
Practice Address - Zip Code:94501-1033
Practice Address - Country:US
Practice Address - Phone:510-227-5540
Practice Address - Fax:510-373-2339
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-14
Last Update Date:2020-01-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA81083207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A810830Medicaid
CAA81038OtherCALIFORNIA LICENSE NUMBER
CA00A810830Medicare ID - Type Unspecified