Provider Demographics
NPI:1588720916
Name:RANDHAWA, TEJINDER SINGH (MD)
Entity type:Individual
Prefix:
First Name:TEJINDER
Middle Name:SINGH
Last Name:RANDHAWA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 25578
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93729-5578
Mailing Address - Country:US
Mailing Address - Phone:559-455-1500
Mailing Address - Fax:559-253-1302
Practice Address - Street 1:805 FRESNO ST
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93706-3118
Practice Address - Country:US
Practice Address - Phone:559-455-1500
Practice Address - Fax:559-253-1302
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-29
Last Update Date:2009-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA53378208D00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA53378OtherMEDICAL BOARD LICENSE
CA00A533780OtherMEDI-CAL PROVIDER NUMBER
CA00A533781OtherMEDI-CAL PROVIDER NUMBER