Provider Demographics
NPI:1912000126
Name:BAJWA, KULBIR K (MD)
Entity Type:Individual
Prefix:
First Name:KULBIR
Middle Name:K
Last Name:BAJWA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:421 NUT TREE RD
Mailing Address - Street 2:
Mailing Address - City:VACAVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95687-3508
Mailing Address - Country:US
Mailing Address - Phone:707-624-7500
Mailing Address - Fax:707-624-7501
Practice Address - Street 1:421 NUT TREE RD
Practice Address - Street 2:
Practice Address - City:VACAVILLE
Practice Address - State:CA
Practice Address - Zip Code:95687-3508
Practice Address - Country:US
Practice Address - Phone:707-624-7500
Practice Address - Fax:707-624-7501
Is Sole Proprietor?:No
Enumeration Date:2006-09-06
Last Update Date:2010-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC51042207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00C510420Medicaid
CA00C510420Medicare PIN
CA00C510420Medicaid