Provider Demographics
NPI:1356518013
Name:SARBPAUL S BHALLA, MD A MEDICAL CORPORATION
Entity type:Organization
Organization Name:SARBPAUL S BHALLA, MD A MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SARBPAUL
Authorized Official - Middle Name:S
Authorized Official - Last Name:BHALLA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:562-427-8119
Mailing Address - Street 1:3610 LONG BEACH BL, #202
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90807
Mailing Address - Country:US
Mailing Address - Phone:562-427-8119
Mailing Address - Fax:562-427-3760
Practice Address - Street 1:3610 LONG BEACH BL, #202
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90807
Practice Address - Country:US
Practice Address - Phone:562-427-8119
Practice Address - Fax:562-427-3760
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-13
Last Update Date:2024-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA036251174400000X
CAA36251207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
No174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAC08384Medicare UPIN