Provider Demographics
NPI:1124129580
Name:GILL, SUKHPAL K (MD)
Entity type:Individual
Prefix:
First Name:SUKHPAL
Middle Name:K
Last Name:GILL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:550 W DUARTE RD STE 4
Mailing Address - Street 2:
Mailing Address - City:ARCADIA
Mailing Address - State:CA
Mailing Address - Zip Code:91007-7360
Mailing Address - Country:US
Mailing Address - Phone:626-445-7500
Mailing Address - Fax:626-445-7555
Practice Address - Street 1:550 W DUARTE RD STE 4
Practice Address - Street 2:
Practice Address - City:ARCADIA
Practice Address - State:CA
Practice Address - Zip Code:91007-7360
Practice Address - Country:US
Practice Address - Phone:626-445-7500
Practice Address - Fax:626-445-7555
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-26
Last Update Date:2014-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA47807207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A478070OtherBC/BS
CA00A478071Medicaid
CA110163742OtherRAILROAD
CA00A478070OtherBC/BS
CA110163742OtherRAILROAD