Provider Demographics
NPI:1811617111
Name:DR JASJOT BHULLAR, LLC
Entity type:Organization
Organization Name:DR JASJOT BHULLAR, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JASJOT
Authorized Official - Middle Name:KAUR
Authorized Official - Last Name:BHULLAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD, FAHA
Authorized Official - Phone:207-689-7007
Mailing Address - Street 1:841 OAKCREST RD
Mailing Address - Street 2:
Mailing Address - City:SPARTANBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29301-5337
Mailing Address - Country:US
Mailing Address - Phone:864-381-7006
Mailing Address - Fax:
Practice Address - Street 1:1650 SKYLYN DR STE 370
Practice Address - Street 2:
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29307-1047
Practice Address - Country:US
Practice Address - Phone:864-764-4455
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-29
Last Update Date:2023-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
No261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical SpecialtyGroup - Single Specialty