Provider Demographics
NPI:1982817755
Name:RANDHAWA, KANWALDEEP SINGH (MD)
Entity Type:Individual
Prefix:DR
First Name:KANWALDEEP
Middle Name:SINGH
Last Name:RANDHAWA
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1300 ETHAN WAY
Mailing Address - Street 2:STE 600
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95825-2296
Mailing Address - Country:US
Mailing Address - Phone:916-786-7498
Mailing Address - Fax:916-786-2715
Practice Address - Street 1:5 MEDICAL PLAZA DR
Practice Address - Street 2:SUITE 190
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95661-2865
Practice Address - Country:US
Practice Address - Phone:916-786-7498
Practice Address - Fax:916-786-2715
Is Sole Proprietor?:No
Enumeration Date:2007-05-08
Last Update Date:2021-07-06
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Provider Licenses
StateLicense IDTaxonomies
CAA92776207R00000X, 207RC0200X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CABF962YMedicare PIN