Provider Demographics
NPI:1740478783
Name:HTEIN, SANDY (MD)
Entity type:Individual
Prefix:
First Name:SANDY
Middle Name:
Last Name:HTEIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MA SANDY
Other - Middle Name:
Other - Last Name:RAZAK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:22706 FONTHILL AVE
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90505-2833
Mailing Address - Country:US
Mailing Address - Phone:832-754-8417
Mailing Address - Fax:
Practice Address - Street 1:3240 SAWTELLE BLVD
Practice Address - Street 2:#303
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90066-1665
Practice Address - Country:US
Practice Address - Phone:310-397-5165
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-03
Last Update Date:2021-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA96765174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist