Provider Demographics
NPI:1366602229
Name:BHULLAR, JASJOT K (MD)
Entity type:Individual
Prefix:
First Name:JASJOT
Middle Name:K
Last Name:BHULLAR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:JASJOT
Other - Middle Name:KAUR
Other - Last Name:GARCHA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1362 PAIGE LN
Mailing Address - Street 2:
Mailing Address - City:REDLANDS
Mailing Address - State:CA
Mailing Address - Zip Code:92373-6845
Mailing Address - Country:US
Mailing Address - Phone:207-689-7007
Mailing Address - Fax:
Practice Address - Street 1:11234 ANDERSON ST
Practice Address - Street 2:
Practice Address - City:LOMA LINDA
Practice Address - State:CA
Practice Address - Zip Code:92354-2804
Practice Address - Country:US
Practice Address - Phone:909-580-4000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-13
Last Update Date:2024-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC194882207RN0300X
MA258040207RN0300X
PAMT183430207RN0300X
ME018111207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC8598OtherMEDICARE
SC392355Medicaid
ME434197699Medicaid
MA110099758AMedicaid
ME001125701Medicare PIN