Provider Demographics
NPI:1982687828
Name:KHALSA, SIRI CHAND K (MD)
Entity type:Individual
Prefix:
First Name:SIRI CHAND
Middle Name:K
Last Name:KHALSA
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9880 BOBCAT CT
Mailing Address - Street 2:
Mailing Address - City:GILROY
Mailing Address - State:CA
Mailing Address - Zip Code:95020-9365
Mailing Address - Country:US
Mailing Address - Phone:480-747-3083
Mailing Address - Fax:
Practice Address - Street 1:9880 BOBCAT CT
Practice Address - Street 2:
Practice Address - City:GILROY
Practice Address - State:CA
Practice Address - Zip Code:95020-9365
Practice Address - Country:US
Practice Address - Phone:480-747-3083
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-23
Last Update Date:2025-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA107552207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ973843Medicaid
AZ105799Medicare ID - Type Unspecified
AZ973843Medicaid