Provider Demographics
NPI:1346380359
Name:SANDHU, KULDIP (MD)
Entity Type:Individual
Prefix:
First Name:KULDIP
Middle Name:
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 1:3400 DATA DR
Mailing Address - Street 2:PHYSICIAN SUPPORT SERVICES
Mailing Address - City:RANCHO CORDOVA
Mailing Address - State:CA
Mailing Address - Zip Code:95670-7956
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6555 COYLE AVE
Practice Address - Street 2:SUITE 341
Practice Address - City:CARMICHAEL
Practice Address - State:CA
Practice Address - Zip Code:95608-0302
Practice Address - Country:US
Practice Address - Phone:916-536-2596
Practice Address - Fax:916-536-2498
Is Sole Proprietor?:No
Enumeration Date:2007-02-07
Last Update Date:2014-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA37098207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ29516ZOtherMEDICARE ID - LINCOLN
CAZZZ13842ZOtherMEDICARE ID - CARMICHAEL
CAA37098OtherCA MEDICAL LICENSE
CAZZZ13841ZOtherMEDICARE ID - ROSEVILLE
CAZZZ43589ZOtherMEDICARE SUBMITTER ID
CAA37098OtherCA MEDICAL LICENSE
CAA28294Medicare UPIN