Provider Demographics
NPI:1396023032
Name:SIDHU, JASPREET (DO)
Entity Type:Individual
Prefix:
First Name:JASPREET
Middle Name:
Last Name:SIDHU
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2488 N CALIFORNIA ST
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95204-5508
Mailing Address - Country:US
Mailing Address - Phone:209-948-3333
Mailing Address - Fax:209-948-2665
Practice Address - Street 1:2488 N CALIFORNIA ST
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95204
Practice Address - Country:US
Practice Address - Phone:209-948-3333
Practice Address - Fax:209-948-2665
Is Sole Proprietor?:No
Enumeration Date:2011-07-29
Last Update Date:2018-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN60579207X00000X, 207XX0801X
PAOT014143207X00000X
CA20A15530207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No207XX0801XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Trauma