Provider Demographics
NPI:1811928542
Name:SODHI, DATAR SINGH (MD)
Entity type:Individual
Prefix:
First Name:DATAR
Middle Name:SINGH
Last Name:SODHI
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 1:741 S ORANGE AVE FL 1
Mailing Address - Street 2:
Mailing Address - City:WEST COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91790-2662
Mailing Address - Country:US
Mailing Address - Phone:626-960-7117
Mailing Address - Fax:626-813-1038
Practice Address - Street 1:741 S ORANGE AVE FL 1
Practice Address - Street 2:
Practice Address - City:WEST COVINA
Practice Address - State:CA
Practice Address - Zip Code:91790-2662
Practice Address - Country:US
Practice Address - Phone:626-960-7117
Practice Address - Fax:626-813-1038
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2010-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA34032207RP1001X, 207RS0012X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA00340320Medicaid
CACN413ZMedicare PIN
CAA27339Medicare UPIN
CAA00340320Medicaid