Provider Demographics
NPI:1063416410
Name:GUJRAL, INDERPAL SINGH (MD)
Entity type:Individual
Prefix:
First Name:INDERPAL
Middle Name:SINGH
Last Name:GUJRAL
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 1:18 NEWCASTLE LN
Mailing Address - Street 2:
Mailing Address - City:LAGUNA NIGUEL
Mailing Address - State:CA
Mailing Address - Zip Code:92677-9327
Mailing Address - Country:US
Mailing Address - Phone:949-716-7981
Mailing Address - Fax:949-716-7982
Practice Address - Street 1:24953 PASEO DE VALENCIA
Practice Address - Street 2:30 A
Practice Address - City:LAGUNA HILLS
Practice Address - State:CA
Practice Address - Zip Code:92653-4342
Practice Address - Country:US
Practice Address - Phone:949-716-7981
Practice Address - Fax:949-716-7982
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-13
Last Update Date:2022-06-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA49536207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAF31113Medicare UPIN