Provider Demographics
NPI:1396789970
Name:SANDHU, JASBIR SINGH (MEDICAL DOCTOR)
Entity type:Individual
Prefix:
First Name:JASBIR
Middle Name:SINGH
Last Name:SANDHU
Suffix:
Gender:M
Credentials:MEDICAL DOCTOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 6980
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:CA
Mailing Address - Zip Code:93539-6980
Mailing Address - Country:US
Mailing Address - Phone:661-945-0818
Mailing Address - Fax:661-945-8095
Practice Address - Street 1:41324 12TH ST W
Practice Address - Street 2:209
Practice Address - City:PALMDALE
Practice Address - State:CA
Practice Address - Zip Code:93551-1466
Practice Address - Country:US
Practice Address - Phone:661-945-0818
Practice Address - Fax:661-945-8095
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2020-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG32658174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA91465Medicare UPIN