1902885924 NPI number — HARJOT SIDHU MD

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1902885924 NPI number — HARJOT SIDHU MD

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:

SIDHU

Provider First Name:

HARJOT

Provider Middle Name:

Provider Name Prefix Text:

Provider Name Suffix Text:

Provider Credential Text:

MD

Provider Gender Code:

F

Provider Other Organization Name:

Provider Other Organization Name Type Code:

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:

1902885924

Entity Type Code:

Individual

Replacement NPI:

Last Update Date:

03/14/2023

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

1901 N CALIFORNIA ST

Provider Second Line Business Mailing Address:

Provider Business Mailing Address City Name:

STOCKTON

Provider Business Mailing Address State Name:

CA

Provider Business Mailing Address Postal Code:

95204-6005

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

Provider Business Mailing Address Fax Number:

Provider First Line Business Practice Location Address:

1901 N. CALIFORNIA ST.

Provider Second Line Business Practice Location Address:

DIGNITY HEALTH CARE / SJMG

Provider Business Practice Location Address City Name:

STOCKTON

Provider Business Practice Location Address State Name:

CA

Provider Business Practice Location Address Postal Code:

95204

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

209-946-6800

Provider Business Practice Location Address Fax Number:

209-946-6805

Provider Enumeration Date:

01/10/2006

Authorized Official Last Name:

Authorized Official First Name:

Authorized Official Middle Name:

Authorized Official Title or Position:

Authorized Official Telephone Number:

• Taxonomy code: 207R00000X , with the licence number:  47457 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 207RG0100X , with the licence number: 38593 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 207RG0100X , with the licence number: 47457 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 207RG0100X , with the licence number: C54946 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

• Identifier: 040933200 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".
• Identifier: NA2951042895 . This is a "PREFFERED ONE" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
• Identifier: 2450023 . This is a "MEDICAID" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".
• Identifier: 2316540 . This is a "AMERICAS PPO" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
• Identifier: 41084933956001C005 . This is a "CHAMPUS" identifier . This identifiers is of the category "OTHER".
• Identifier: 132592 . This is a "UCARE" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
• Identifier: 2900368 . This is a "MEDICA" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
• Identifier: 944S8SI . This is a "BCBS" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
• Identifier: HP49006 . This is a "HEALTH PARTNERS" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".