Provider Demographics
NPI:1952383614
Name:SIDHU, KULDEEP SINGH (MD)
Entity Type:Individual
Prefix:DR
First Name:KULDEEP
Middle Name:SINGH
Last Name:SIDHU
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 1:1450 BESSIE AVE
Mailing Address - Street 2:
Mailing Address - City:TRACY
Mailing Address - State:CA
Mailing Address - Zip Code:95376-3417
Mailing Address - Country:US
Mailing Address - Phone:209-835-4888
Mailing Address - Fax:209-835-6424
Practice Address - Street 1:1450 BESSIE AVE
Practice Address - Street 2:
Practice Address - City:TRACY
Practice Address - State:CA
Practice Address - Zip Code:95376-3417
Practice Address - Country:US
Practice Address - Phone:209-835-4888
Practice Address - Fax:209-835-6424
Is Sole Proprietor?:No
Enumeration Date:2005-11-17
Last Update Date:2010-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA38277207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA382770OtherCA MEDICAL LICENSE NO
CA00002OtherUNITED HEALTHCARE
CA027942OtherHILL PHYSICIANS
CAA00038277OtherBLUE CROSS
CAZZZ59760ZOtherBLUE SHIELD
CA015789OtherHEALTH NET
CA17463OtherINTERPLAN
CA4310746OtherAETNA
CA027942OtherHILL PHYSICIANS