Provider Demographics
NPI:1881610137
Name:SANDHU, AJAY PAL S (MD)
Entity type:Individual
Prefix:DR
First Name:AJAY PAL
Middle Name:S
Last Name:SANDHU
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:3855 HEALTH SCIENCES DR
Mailing Address - Street 2:MAIL CODE 0843
Mailing Address - City:LA JOLLA
Mailing Address - State:CA
Mailing Address - Zip Code:92093-1503
Mailing Address - Country:US
Mailing Address - Phone:858-822-6055
Mailing Address - Fax:858-822-6081
Practice Address - Street 1:3855 HEALTH SCIENCES DR
Practice Address - Street 2:MAIL CODE 0843
Practice Address - City:LA JOLLA
Practice Address - State:CA
Practice Address - Zip Code:92093-1503
Practice Address - Country:US
Practice Address - Phone:858-822-6055
Practice Address - Fax:858-822-6081
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2009-03-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA699472085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A699470Medicaid
CABG372ZMedicare PIN
CAWA69947AMedicare PIN
CA00A699470Medicaid