Provider Demographics
NPI:1891277588
Name:BHANGU, SUNDEEP SINGH
Entity Type:Individual
Prefix:
First Name:SUNDEEP
Middle Name:SINGH
Last Name:BHANGU
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 1:3080 ENFIELD ST
Mailing Address - Street 2:
Mailing Address - City:SAN RAMON
Mailing Address - State:CA
Mailing Address - Zip Code:94582-5807
Mailing Address - Country:US
Mailing Address - Phone:925-890-2059
Mailing Address - Fax:
Practice Address - Street 1:3080 ENFIELD ST
Practice Address - Street 2:
Practice Address - City:SAN RAMON
Practice Address - State:CA
Practice Address - Zip Code:94582-5807
Practice Address - Country:US
Practice Address - Phone:925-890-2059
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-30
Last Update Date:2022-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT295135225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist