Provider Demographics
NPI:1356714745
Name:EXCEL KIDNEY CARE INC A PROFESSIONAL MEDICAL CORPORATION
Entity type:Organization
Organization Name:EXCEL KIDNEY CARE INC A PROFESSIONAL MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:DR
Authorized Official - First Name:RANDEEP
Authorized Official - Middle Name:S
Authorized Official - Last Name:BAJWA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:209-825-2047
Mailing Address - Street 1:1140 NORMAN DR STE 104
Mailing Address - Street 2:
Mailing Address - City:MANTECA
Mailing Address - State:CA
Mailing Address - Zip Code:95336-5900
Mailing Address - Country:US
Mailing Address - Phone:209-943-0851
Mailing Address - Fax:
Practice Address - Street 1:1144 NORMAN DR STE 303
Practice Address - Street 2:
Practice Address - City:MANTECA
Practice Address - State:CA
Practice Address - Zip Code:95336-5925
Practice Address - Country:US
Practice Address - Phone:209-888-4340
Practice Address - Fax:209-888-4371
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-06
Last Update Date:2023-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA3692662207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty