Provider Demographics
NPI:1083631626
Name:SIDHU, SATWANT (MD MSPH)
Entity type:Individual
Prefix:
First Name:SATWANT
Middle Name:
Last Name:SIDHU
Suffix:
Gender:F
Credentials:MD MSPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7515 VAN NUYS BOULEVARD
Mailing Address - Street 2:5TH FLOOR
Mailing Address - City:VAN NUYS
Mailing Address - State:CA
Mailing Address - Zip Code:91405
Mailing Address - Country:US
Mailing Address - Phone:818-947-4026
Mailing Address - Fax:818-989-8850
Practice Address - Street 1:7515 VAN NUYS BOULEVARD
Practice Address - Street 2:5TH FLOOR
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91405
Practice Address - Country:US
Practice Address - Phone:818-947-4026
Practice Address - Fax:818-989-8850
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA0251382083P0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
F63103Medicare UPIN