Provider Demographics
NPI:1205058856
Name:SEKHON, SANDEEP SINGH (MD)
Entity type:Individual
Prefix:DR
First Name:SANDEEP
Middle Name:SINGH
Last Name:SEKHON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1187 E HERNDON AVE
Mailing Address - Street 2:#101
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93720-3166
Mailing Address - Country:US
Mailing Address - Phone:559-440-0450
Mailing Address - Fax:559-440-0253
Practice Address - Street 1:1187 E HERNDON AVE
Practice Address - Street 2:#101
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93720-3166
Practice Address - Country:US
Practice Address - Phone:559-440-0450
Practice Address - Fax:559-440-0253
Is Sole Proprietor?:No
Enumeration Date:2007-05-03
Last Update Date:2015-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMT048452T207RG0100X
CAA109110207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2776723Medicaid
WV3810009046Medicaid
PA1019300980001Medicaid
CA00A109110OtherCALIFORNIA LICENSE
WV3810009046Medicaid
PA1019300980001Medicaid