Provider Demographics
NPI:1700932084
Name:MOHINDER S NIJJAR MD INC
Entity Type:Organization
Organization Name:MOHINDER S NIJJAR MD INC
Other - Org Name:PROFESSIONAL CORP MOHINDER S NIJJAR MD INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER DBA
Authorized Official - Prefix:DR
Authorized Official - First Name:MOHINDER
Authorized Official - Middle Name:
Authorized Official - Last Name:NIJJAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:209-531-3600
Mailing Address - Street 1:PO BOX 576568
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95357-6568
Mailing Address - Country:US
Mailing Address - Phone:209-531-3600
Mailing Address - Fax:209-545-3355
Practice Address - Street 1:1400 FLORIDA AVE
Practice Address - Street 2:SUITE 8
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95350-4446
Practice Address - Country:US
Practice Address - Phone:800-245-7899
Practice Address - Fax:209-545-3355
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-26
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA36057207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA36057OtherMEDICAL PRACTICE
CAA36057OtherCAILIC NUMBER
ANU647666OtherDEA