Provider Demographics
NPI:1669790838
Name:BHASIN, NITIN (MD)
Entity type:Individual
Prefix:
First Name:NITIN
Middle Name:
Last Name:BHASIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1335 CYPRESS STREET,
Mailing Address - Street 2:SUITE 205
Mailing Address - City:SAN DIMAS
Mailing Address - State:CA
Mailing Address - Zip Code:91773-3538
Mailing Address - Country:US
Mailing Address - Phone:909-542-2777
Mailing Address - Fax:909-394-1800
Practice Address - Street 1:1335 CYPRESS STREET,
Practice Address - Street 2:SUITE 205
Practice Address - City:SAN DIMAS
Practice Address - State:CA
Practice Address - Zip Code:91773-3538
Practice Address - Country:US
Practice Address - Phone:909-542-2777
Practice Address - Fax:909-394-1800
Is Sole Proprietor?:No
Enumeration Date:2010-05-12
Last Update Date:2020-08-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA109234207R00000X, 207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine