1790929263 NPI number — DR. NINA KAUR SANDHU DO

Table of content: DR. NINA KAUR SANDHU DO (NPI 1790929263)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1790929263 NPI number — DR. NINA KAUR SANDHU DO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SANDHU
Provider First Name:
NINA
Provider Middle Name:
KAUR
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DO
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SANDHU
Provider Other First Name:
NINA
Provider Other Middle Name:
KAUR
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
DO
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1790929263
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/18/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3801 GASTON AVE
Provider Second Line Business Mailing Address:
SUITE 318- 320
Provider Business Mailing Address City Name:
DALLAS
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75246-1541
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
214-821-3591
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3801 GASTON AVE
Provider Second Line Business Practice Location Address:
#320
Provider Business Practice Location Address City Name:
DALLAS
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75246
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
214-821-3591
Provider Business Practice Location Address Fax Number:
214-821-3594
Provider Enumeration Date:
04/28/2009

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: 207LP2900X , with the licence number:  Q0557 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208VP0014X , with the licence number: Q0557 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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