Provider Demographics
NPI:1649579384
Name:SANDHU, SUJAN K (MD)
Entity Type:Individual
Prefix:
First Name:SUJAN
Middle Name:K
Last Name:SANDHU
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2067 W VISTA WAY
Mailing Address - Street 2:SUITE 180
Mailing Address - City:VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:92083-6031
Mailing Address - Country:US
Mailing Address - Phone:760-945-3434
Mailing Address - Fax:760-945-6761
Practice Address - Street 1:2067 W VISTA WAY
Practice Address - Street 2:SUITE 180
Practice Address - City:VISTA
Practice Address - State:CA
Practice Address - Zip Code:92083-6031
Practice Address - Country:US
Practice Address - Phone:760-945-3434
Practice Address - Fax:760-945-6761
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-21
Last Update Date:2022-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA110410208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A110410Medicaid