Provider Demographics
NPI:1811381825
Name:HUSSAIN, SANDAL (MD)
Entity Type:Individual
Prefix:
First Name:SANDAL
Middle Name:
Last Name:HUSSAIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:SANDAL
Other - Middle Name:
Other - Last Name:SALEEM
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:3400 DATA DR
Mailing Address - Street 2:
Mailing Address - City:RANCHO CORDOVA
Mailing Address - State:CA
Mailing Address - Zip Code:95670-7956
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:830 JEFFERSON AVE STE M
Practice Address - Street 2:
Practice Address - City:REDWOOD CITY
Practice Address - State:CA
Practice Address - Zip Code:94063-1804
Practice Address - Country:US
Practice Address - Phone:650-861-0616
Practice Address - Fax:650-381-0617
Is Sole Proprietor?:No
Enumeration Date:2015-03-27
Last Update Date:2024-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA1717912080P0204X, 2080P0204X
NV210522080P0204X
MI43011142902080P0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0204XAllopathic & Osteopathic PhysiciansPediatricsPediatric Emergency Medicine