Provider Demographics
NPI:1295882769
Name:GILL, KULDIP SINGH (MD)
Entity type:Individual
Prefix:
First Name:KULDIP
Middle Name:SINGH
Last Name:GILL
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 1:280 SIERRA COLLEGE DR.
Mailing Address - Street 2:SUTIE 205
Mailing Address - City:GRASS VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:95945-5701
Mailing Address - Country:US
Mailing Address - Phone:530-273-8452
Mailing Address - Fax:530-477-5182
Practice Address - Street 1:280 SIERRA COLLEGE DR.
Practice Address - Street 2:SUITE 205
Practice Address - City:GRASS VALLEY
Practice Address - State:CA
Practice Address - Zip Code:95945-5701
Practice Address - Country:US
Practice Address - Phone:530-273-8452
Practice Address - Fax:530-477-5182
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-05
Last Update Date:2017-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA61538207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A0615381Medicaid
CAA061538OtherSTATE LICENSE
CAG12425Medicare UPIN
CA00A0615381Medicaid