Provider Demographics
NPI:1629376264
Name:SANDHU, JAYTINDER SINGH (DPM)
Entity Type:Individual
Prefix:DR
First Name:JAYTINDER
Middle Name:SINGH
Last Name:SANDHU
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2120 N MACARTHUR BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75061-2260
Mailing Address - Country:US
Mailing Address - Phone:972-438-4636
Mailing Address - Fax:972-438-2077
Practice Address - Street 1:2120 N MACARTHUR BLVD STE 100
Practice Address - Street 2:
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75061-2260
Practice Address - Country:US
Practice Address - Phone:972-438-4636
Practice Address - Fax:972-438-2077
Is Sole Proprietor?:No
Enumeration Date:2011-03-07
Last Update Date:2014-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2022213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXTXB161790Medicare PIN