1891259529 NPI number — SANDEEP SODHI MD INC

Table of content: JACQUELINE REESE WALTER PHD, OTR/L, CHT (NPI 1225143381)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1891259529 NPI number — SANDEEP SODHI MD INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SANDEEP SODHI MD INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
NEW AGE ENDOCRINOLOGY
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1891259529
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/24/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
12 LAKESIDE DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BUENA PARK
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90621-1656
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
369 SAN MIGUEL DR STE 200
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEWPORT BEACH
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92660-7850
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
949-630-0008
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/28/2019

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
SODHI
Authorized Official First Name:
SANDEEP
Authorized Official Middle Name:
Authorized Official Title or Position:
ENDOCRINOLOGIST
Authorized Official Telephone Number:
714-253-2777

Provider Taxonomy Codes

  • Taxonomy code: 174400000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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