Provider Demographics
NPI:1871155259
Name:GAGANDEEPSINGH&TIMONTHYJOHNSTON
Entity type:Organization
Organization Name:GAGANDEEPSINGH&TIMONTHYJOHNSTON
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER,RN
Authorized Official - Prefix:MRS
Authorized Official - First Name:HARSIMRAT
Authorized Official - Middle Name:KAUR
Authorized Official - Last Name:BAINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-964-3919
Mailing Address - Street 1:836 ROUND HILL DR
Mailing Address - Street 2:
Mailing Address - City:MERCED
Mailing Address - State:CA
Mailing Address - Zip Code:95348-8422
Mailing Address - Country:US
Mailing Address - Phone:718-964-3919
Mailing Address - Fax:
Practice Address - Street 1:650 W OLIVE AVE
Practice Address - Street 2:
Practice Address - City:MERCED
Practice Address - State:CA
Practice Address - Zip Code:95348-2423
Practice Address - Country:US
Practice Address - Phone:718-964-3919
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-05
Last Update Date:2019-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207QA0000XAllopathic & Osteopathic PhysiciansFamily MedicineAdolescent MedicineGroup - Multi-Specialty
No207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult MedicineGroup - Multi-Specialty
No207QH0002XAllopathic & Osteopathic PhysiciansFamily MedicineHospice and Palliative MedicineGroup - Multi-Specialty
No207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1093074429Medicaid
CA1528097847Medicaid