Provider Demographics
NPI:1396713822
Name:SIDHU, AMARPAUL S (MD)
Entity type:Individual
Prefix:
First Name:AMARPAUL
Middle Name:S
Last Name:SIDHU
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 1:2301 E FOOTHILL BLVD
Mailing Address - Street 2:100
Mailing Address - City:GLENDORA
Mailing Address - State:CA
Mailing Address - Zip Code:91740-4000
Mailing Address - Country:US
Mailing Address - Phone:626-852-3376
Mailing Address - Fax:626-852-3375
Practice Address - Street 1:2301 E FOOTHILL BLVD
Practice Address - Street 2:100
Practice Address - City:GLENDORA
Practice Address - State:CA
Practice Address - Zip Code:91740-4000
Practice Address - Country:US
Practice Address - Phone:626-852-3376
Practice Address - Fax:626-852-3375
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-10
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA73248174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A732480Medicaid
CAH95924Medicare UPIN