Basic Information
Provider Information
NPI: 1093177990
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: HANSRA
FirstName: RAJKAMAL
MiddleName: SINGH
NamePrefix: DR.
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1300 ETHAN WAY STE 600
Address2:  
City: SACRAMENTO
State: CA
PostalCode: 958252296
CountryCode: US
TelephoneNumber: 9164827623
FaxNumber: 9164823647
Practice Location
Address1: 5 MEDICAL PLAZA DR STE 190
Address2:  
City: ROSEVILLE
State: CA
PostalCode: 956612867
CountryCode: US
TelephoneNumber: 9167867498
FaxNumber: 9167862715
Other Information
ProviderEnumerationDate: 03/22/2016
LastUpdateDate: 08/05/2022
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 08/05/2022

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207RP1001XA176797CAY Allopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
207R00000XA176797CAN Allopathic & Osteopathic PhysiciansInternal Medicine 

No ID Information.


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