Provider Demographics
NPI:1184820961
Name:ADEL SANDOUK, M.D., INC
Entity Type:Organization
Organization Name:ADEL SANDOUK, M.D., INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DR.
Authorized Official - Prefix:DR
Authorized Official - First Name:ADEL
Authorized Official - Middle Name:
Authorized Official - Last Name:SANDOUK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:626-914-2900
Mailing Address - Street 1:PO BOX 122
Mailing Address - Street 2:
Mailing Address - City:GLENDORA
Mailing Address - State:CA
Mailing Address - Zip Code:91740-0122
Mailing Address - Country:US
Mailing Address - Phone:626-914-2900
Mailing Address - Fax:626-331-3832
Practice Address - Street 1:210 S GRAND AVE STE 307
Practice Address - Street 2:
Practice Address - City:GLENDORA
Practice Address - State:CA
Practice Address - Zip Code:91741-4278
Practice Address - Country:US
Practice Address - Phone:626-914-2900
Practice Address - Fax:626-331-3832
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-27
Last Update Date:2020-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA86608207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA86608Medicare PIN
CAG31609Medicare UPIN
CAW20856Medicare PIN