Provider Demographics
NPI:1871057067
Name:JAGDEV SINGH HEIR MD PROF CORP
Entity type:Organization
Organization Name:JAGDEV SINGH HEIR MD PROF CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT & CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:JAGDEV
Authorized Official - Middle Name:SINGH
Authorized Official - Last Name:HEIR
Authorized Official - Suffix:
Authorized Official - Credentials:MD, DMD, FACS
Authorized Official - Phone:518-441-5483
Mailing Address - Street 1:4170 TRUXEL RD STE C
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95834-3758
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4170 TRUXEL RD STE C
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95834-3758
Practice Address - Country:US
Practice Address - Phone:916-419-4588
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-22
Last Update Date:2019-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1376762898OtherINDIVIDUAL NPI - GEORGE BROWNRIDGE, DDS
1033409834OtherINDIVIDUAL NPI - I-TIEN EMILY SHAW, DDS, MD
1851320584OtherINDIVIDUAL NPI - JAGDEV S HEIR, MD, DMD, FACS
1629119300OtherINDIVIDUAL NPI - LILA H KIM, DDS