Provider Demographics
NPI:1437358504
Name:TEJINDER M KALRA, MD
Entity type:Organization
Organization Name:TEJINDER M KALRA, MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:TEJINDER
Authorized Official - Middle Name:M
Authorized Official - Last Name:KALRA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:949-645-1967
Mailing Address - Street 1:415 OLD NEWPORT BLVD
Mailing Address - Street 2:STE 102
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92663-4248
Mailing Address - Country:US
Mailing Address - Phone:949-645-1967
Mailing Address - Fax:949-645-1346
Practice Address - Street 1:415 OLD NEWPORT BLVD
Practice Address - Street 2:STE 102
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92663-4248
Practice Address - Country:US
Practice Address - Phone:949-645-1967
Practice Address - Fax:949-645-1346
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-17
Last Update Date:2007-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA42400207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0052630Medicaid
CAW11500AMedicare PIN
CAA85794Medicare UPIN