Provider Demographics
NPI:1699887513
Name:SINGH, JAGDEV
Entity type:Individual
Prefix:
First Name:JAGDEV
Middle Name:
Last Name:SINGH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6101 N FRESNO ST #102 FRESNO CA 93710
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93710
Mailing Address - Country:US
Mailing Address - Phone:559-435-5576
Mailing Address - Fax:559-435-4618
Practice Address - Street 1:6101 N FRESNO ST #102 FRESNO CA 93710
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93710
Practice Address - Country:US
Practice Address - Phone:559-435-5576
Practice Address - Fax:559-435-4618
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2010-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA00A367820207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A367820Medicaid
00A367820Medicare ID - Type Unspecified
A28181Medicare UPIN