Provider Demographics
NPI:1679876593
Name:THAKUR, SAPAN DILEEP (DPT)
Entity Type:Individual
Prefix:MR
First Name:SAPAN
Middle Name:DILEEP
Last Name:THAKUR
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12572 VALLEY VIEW ST
Mailing Address - Street 2:
Mailing Address - City:GARDEN GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:92845-2006
Mailing Address - Country:US
Mailing Address - Phone:714-823-4400
Mailing Address - Fax:714-823-4404
Practice Address - Street 1:1801 E CHAPMAN AVE
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92867-7775
Practice Address - Country:US
Practice Address - Phone:714-221-2250
Practice Address - Fax:714-221-2255
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-15
Last Update Date:2011-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA36640174400000X, 208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
XDP842A24397OtherBLUE CROSS