Provider Demographics
NPI:1265795744
Name:SANDHU, BASANT SINGH (MD)
Entity type:Individual
Prefix:DR
First Name:BASANT
Middle Name:SINGH
Last Name:SANDHU
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 1:425 N DATE ST
Mailing Address - Street 2:
Mailing Address - City:ESCONDIDO
Mailing Address - State:CA
Mailing Address - Zip Code:92025-3413
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:903 E DEVONSHIRE AVE
Practice Address - Street 2:STE D
Practice Address - City:HEMET
Practice Address - State:CA
Practice Address - Zip Code:92543-3000
Practice Address - Country:US
Practice Address - Phone:951-216-6100
Practice Address - Fax:951-765-3075
Is Sole Proprietor?:No
Enumeration Date:2012-06-20
Last Update Date:2017-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA09742800207Q00000X
CAA140398207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACA225687Medicare UPIN