Provider Demographics
NPI:1811221674
Name:SINGH, KULWANT (MD)
Entity Type:Individual
Prefix:
First Name:KULWANT
Middle Name:
Last Name:SINGH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5000 WINDPLAY DR
Mailing Address - Street 2:ST 4
Mailing Address - City:EL DORADO HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:95762-9365
Mailing Address - Country:US
Mailing Address - Phone:916-984-6111
Mailing Address - Fax:916-293-8152
Practice Address - Street 1:2545 E BIDWELL ST
Practice Address - Street 2:SUITE 110
Practice Address - City:FOLSOM
Practice Address - State:CA
Practice Address - Zip Code:95630-6440
Practice Address - Country:US
Practice Address - Phone:916-984-6111
Practice Address - Fax:916-983-1717
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-28
Last Update Date:2017-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA1050952084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA105095OtherCALIFORNIA MEDICAL BOARD
CAD1753YMedicare UPIN