Provider Demographics
NPI:1942378773
Name:VIRK, JASWANT G (MD)
Entity Type:Individual
Prefix:
First Name:JASWANT
Middle Name:G
Last Name:VIRK
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 1:6588 ROSE BRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95678-3430
Mailing Address - Country:US
Mailing Address - Phone:916-367-3596
Mailing Address - Fax:
Practice Address - Street 1:11600 EDUCATION ST
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:CA
Practice Address - Zip Code:95602-2468
Practice Address - Country:US
Practice Address - Phone:530-889-0707
Practice Address - Fax:530-889-0723
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-01
Last Update Date:2015-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00048708207R00000X
CAA116251207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine