Provider Demographics
NPI:1255958476
Name:GOLDEN STATE MEDICAL GROUP
Entity type:Organization
Organization Name:GOLDEN STATE MEDICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWENER
Authorized Official - Prefix:DR
Authorized Official - First Name:JHUJHAR
Authorized Official - Middle Name:
Authorized Official - Last Name:SINGH
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:909-694-4016
Mailing Address - Street 1:4959 PALO VERDE ST STE 206A-5
Mailing Address - Street 2:
Mailing Address - City:MONTCLAIR
Mailing Address - State:CA
Mailing Address - Zip Code:91763-2342
Mailing Address - Country:US
Mailing Address - Phone:909-694-4016
Mailing Address - Fax:909-920-3344
Practice Address - Street 1:4959 PALO VERDE ST STE 206A-5
Practice Address - Street 2:
Practice Address - City:MONTCLAIR
Practice Address - State:CA
Practice Address - Zip Code:91763-2342
Practice Address - Country:US
Practice Address - Phone:909-694-4016
Practice Address - Fax:909-920-3344
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-03
Last Update Date:2020-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty