Provider Demographics
NPI:1194250316
Name:BANSAL, SARAJINDER KAUR (MD)
Entity type:Individual
Prefix:MS
First Name:SARAJINDER
Middle Name:KAUR
Last Name:BANSAL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MS
Other - First Name:SARA
Other - Middle Name:KAUR
Other - Last Name:BANSAL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:1101 N CHERRY ST
Mailing Address - Street 2:
Mailing Address - City:TULARE
Mailing Address - State:CA
Mailing Address - Zip Code:93274-2231
Mailing Address - Country:US
Mailing Address - Phone:559-686-9097
Mailing Address - Fax:
Practice Address - Street 1:1101 N CHERRY ST
Practice Address - Street 2:
Practice Address - City:TULARE
Practice Address - State:CA
Practice Address - Zip Code:93274-2231
Practice Address - Country:US
Practice Address - Phone:559-686-9097
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-25
Last Update Date:2020-07-16
Deactivation Date:2017-11-27
Deactivation Code:
Reactivation Date:2017-12-07
Provider Licenses
StateLicense IDTaxonomies
CAA164640207Q00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program