Provider Demographics
NPI:1124103254
Name:RAI, MEETINDER KAUR (MD)
Entity type:Individual
Prefix:
First Name:MEETINDER
Middle Name:KAUR
Last Name:RAI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:MEETINDER
Other - Middle Name:KAUR
Other - Last Name:RAI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:1930 E HATCH RD
Mailing Address - Street 2:STE A
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95351-5141
Mailing Address - Country:US
Mailing Address - Phone:209-531-0552
Mailing Address - Fax:
Practice Address - Street 1:1930 E HATCH RD
Practice Address - Street 2:STE A
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95351-5141
Practice Address - Country:US
Practice Address - Phone:209-531-0552
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-26
Last Update Date:2015-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA49556207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A495560Medicaid
CAA49556OtherLICENSE NUMBER
CAE93736Medicare UPIN
CA00A495560Medicare PIN