Provider Demographics
NPI:1821001009
Name:DOSHI, SANJAY P
Entity Type:Individual
Prefix:
First Name:SANJAY
Middle Name:P
Last Name:DOSHI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3209 S BREA CANYON RD STE F
Mailing Address - Street 2:
Mailing Address - City:DIAMOND BAR
Mailing Address - State:CA
Mailing Address - Zip Code:91765-3482
Mailing Address - Country:US
Mailing Address - Phone:909-240-1748
Mailing Address - Fax:
Practice Address - Street 1:3209 S BREA CANYON RD STE F
Practice Address - Street 2:
Practice Address - City:DIAMOND BAR
Practice Address - State:CA
Practice Address - Zip Code:91765-3482
Practice Address - Country:US
Practice Address - Phone:909-240-1748
Practice Address - Fax:909-364-9622
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-15
Last Update Date:2021-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332BC3200X
CA389861223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment