Provider Demographics
NPI:1437192812
Name:SANDHU, JAGSIR SINGH (MD)
Entity Type:Individual
Prefix:DR
First Name:JAGSIR
Middle Name:SINGH
Last Name:SANDHU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:JAGSIR
Other - Middle Name:S
Other - Last Name:SANDHU
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:1245 E HERNDON AVE
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93720-3235
Mailing Address - Country:US
Mailing Address - Phone:559-450-2273
Mailing Address - Fax:559-450-3050
Practice Address - Street 1:1245 E HERNDON AVE
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93720-3235
Practice Address - Country:US
Practice Address - Phone:559-450-2273
Practice Address - Fax:559-450-3050
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2017-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA69122207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
H27874Medicare UPIN