Provider Demographics
NPI:1720078314
Name:UPPAL, SUKHDEV K (MD)
Entity Type:Individual
Prefix:
First Name:SUKHDEV
Middle Name:K
Last Name:UPPAL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 MAGNOLIA AVE
Mailing Address - Street 2:SUITE 107
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92879-3123
Mailing Address - Country:US
Mailing Address - Phone:951-372-0955
Mailing Address - Fax:951-372-0918
Practice Address - Street 1:800 MAGNOLIA AVE
Practice Address - Street 2:SUITE 107
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92879-3123
Practice Address - Country:US
Practice Address - Phone:951-372-0955
Practice Address - Fax:951-372-0918
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-25
Last Update Date:2018-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA54106208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A541060Medicaid
A54106Medicare UPIN