Provider Demographics
NPI:1669599296
Name:TANDON, JAGJIT SINGH (MD)
Entity type:Individual
Prefix:DR
First Name:JAGJIT
Middle Name:SINGH
Last Name:TANDON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:480 4TH AVE STE 409
Mailing Address - Street 2:
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91910-4413
Mailing Address - Country:US
Mailing Address - Phone:619-425-2080
Mailing Address - Fax:619-425-8410
Practice Address - Street 1:2900 S HIGHWAY 77
Practice Address - Street 2:
Practice Address - City:LYNN HAVEN
Practice Address - State:FL
Practice Address - Zip Code:32444
Practice Address - Country:US
Practice Address - Phone:850-481-1687
Practice Address - Fax:850-640-0761
Is Sole Proprietor?:No
Enumeration Date:2007-03-26
Last Update Date:2021-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME141233207RH0003X
PAMD038233L207RH0003X
CAC172028207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0015360790001Medicaid
PAE15458Medicare UPIN
PA785616Medicare PIN