Provider Demographics
NPI:1508872425
Name:SANDHU, LAKHJIT S (MD)
Entity Type:Individual
Prefix:
First Name:LAKHJIT
Middle Name:S
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 1:7215 N FRESNO ST STE 103
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93720-2969
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7215 N FRESNO ST STE 103
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93720-2969
Practice Address - Country:US
Practice Address - Phone:559-438-1111
Practice Address - Fax:559-438-4002
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2016-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA00A454840174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A454840Medicaid
CAGR0071840Medicaid
CA00A454840Medicaid
CAGR0071840Medicaid