Provider Demographics
NPI:1063456457
Name:SANDHU, SUKHWINDER SINGH (MD)
Entity Type:Individual
Prefix:
First Name:SUKHWINDER
Middle Name:SINGH
Last Name:SANDHU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:734 MOWRY AVE
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94536-4115
Mailing Address - Country:US
Mailing Address - Phone:510-793-3033
Mailing Address - Fax:510-793-4952
Practice Address - Street 1:734 MOWRY AVE
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94536-4115
Practice Address - Country:US
Practice Address - Phone:510-793-3033
Practice Address - Fax:510-793-4952
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG66303207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG66303OtherCOMMERCIAL
CA00G663030Medicaid
CA00G663030OtherBLUE SHIELD AND BLUE CROS
CAG66303OtherCOMMERCIAL
CA00G663030Medicaid