Provider Demographics
NPI:1689259533
Name:JANDU, SUKHBIR K
Entity Type:Individual
Prefix:
First Name:SUKHBIR
Middle Name:K
Last Name:JANDU
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4031 CORALLINE CT
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94555-3317
Mailing Address - Country:US
Mailing Address - Phone:510-862-8400
Mailing Address - Fax:
Practice Address - Street 1:3900 FREEDOM CIR STE 201
Practice Address - Street 2:
Practice Address - City:SANTA CLARA
Practice Address - State:CA
Practice Address - Zip Code:95054-1222
Practice Address - Country:US
Practice Address - Phone:408-342-6699
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-12
Last Update Date:2021-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker