1790853760 NPI number — DR. KARANJIT SINGH BASRAI M.D.

Table of content: DR. KARANJIT SINGH BASRAI M.D. (NPI 1790853760)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1790853760 NPI number — DR. KARANJIT SINGH BASRAI M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BASRAI
Provider First Name:
KARANJIT
Provider Middle Name:
SINGH
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BASRA
Provider Other First Name:
KARANJIT
Provider Other Middle Name:
SINGH
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.D.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1790853760
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/24/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1540 RIVER PARK DR STE 202
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SACRAMENTO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95815-4609
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
916-245-6192
Provider Business Mailing Address Fax Number:
916-245-5619

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
SUTTER ROSEVILLE MEDICAL CENTER.
Provider Second Line Business Practice Location Address:
6, MEDICAL PLAZA DR
Provider Business Practice Location Address City Name:
ROSEVILLE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95661-3037
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
916-878-2669
Provider Business Practice Location Address Fax Number:
916-878-2622
Provider Enumeration Date:
11/30/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 208100000X , with the licence number:  A73010 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)