Provider Demographics
NPI:1285077669
Name:SANDHU, NAGVIR K (DPM)
Entity type:Individual
Prefix:DR
First Name:NAGVIR
Middle Name:K
Last Name:SANDHU
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:NAGVIR
Other - Middle Name:K
Other - Last Name:SIDHU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPM
Mailing Address - Street 1:17097 LONGVIEW CT
Mailing Address - Street 2:
Mailing Address - City:LATHROP
Mailing Address - State:CA
Mailing Address - Zip Code:95330-8262
Mailing Address - Country:US
Mailing Address - Phone:209-505-5168
Mailing Address - Fax:
Practice Address - Street 1:500 W HOSPITAL RD
Practice Address - Street 2:
Practice Address - City:FRENCH CAMP
Practice Address - State:CA
Practice Address - Zip Code:95231-9693
Practice Address - Country:US
Practice Address - Phone:209-468-6022
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-04-16
Last Update Date:2024-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2200213ES0103X
390200000X
CAE5454213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX358898002OtherCSHCN
TX358898001Medicaid
TX506402YK00Medicare UPIN