1346380359 NPI number — KULDIP SANDHU MD

Table of content: KULDIP SANDHU MD (NPI 1346380359)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1346380359 NPI number — KULDIP SANDHU MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SANDHU
Provider First Name:
KULDIP
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

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 Information

NPI Number:
1346380359
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/31/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3400 DATA DR
Provider Second Line Business Mailing Address:
PHYSICIAN SUPPORT SERVICES
Provider Business Mailing Address City Name:
RANCHO CORDOVA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95670-7956
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:
6555 COYLE AVE
Provider Second Line Business Practice Location Address:
SUITE 341
Provider Business Practice Location Address City Name:
CARMICHAEL
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95608-0302
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
916-536-2596
Provider Business Practice Location Address Fax Number:
916-536-2498
Provider Enumeration Date:
02/07/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207RG0100X , with the licence number:  A37098 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: ZZZ29516Z . This is a "MEDICARE ID - LINCOLN" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: ZZZ13842Z . This is a "MEDICARE ID - CARMICHAEL" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: A37098 . This is a "CA MEDICAL LICENSE" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: ZZZ13841Z . This is a "MEDICARE ID - ROSEVILLE" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: ZZZ43589Z . This is a "MEDICARE SUBMITTER ID" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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