Provider Demographics
NPI:1184618399
Name:SACHDEVA, VIRENDER K (MD01/19/1949)
Entity type:Individual
Prefix:DR
First Name:VIRENDER
Middle Name:K
Last Name:SACHDEVA
Suffix:
Gender:M
Credentials:MD01/19/1949
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:175 N JACKSON AVE
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95116-1909
Mailing Address - Country:US
Mailing Address - Phone:408-926-1340
Mailing Address - Fax:408-926-1779
Practice Address - Street 1:175 N JACKSON AVE
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95116-1909
Practice Address - Country:US
Practice Address - Phone:408-926-1340
Practice Address - Fax:408-926-1779
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA35415208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A35415Medicaid
CA00A35415Medicaid