Provider Demographics
NPI:1528214590
Name:KUKREJA, SACHIN SURESH (MD)
Entity Type:Individual
Prefix:DR
First Name:SACHIN
Middle Name:SURESH
Last Name:KUKREJA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1411 N BECKLEY AVE STE 454
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75203-1262
Mailing Address - Country:US
Mailing Address - Phone:469-620-0222
Mailing Address - Fax:469-620-0223
Practice Address - Street 1:1411 N BECKLEY AVE STE 454
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75203-1262
Practice Address - Country:US
Practice Address - Phone:469-620-0222
Practice Address - Fax:469-620-0223
Is Sole Proprietor?:No
Enumeration Date:2008-08-11
Last Update Date:2023-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXP5098208600000X
IL036118577208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX548454Medicare PIN