Provider Demographics
NPI:1285751222
Name:SANJIV K MIDHA MD
Entity type:Organization
Organization Name:SANJIV K MIDHA MD
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SANJIV
Authorized Official - Middle Name:
Authorized Official - Last Name:MIDHA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:530-674-2100
Mailing Address - Street 1:2017 EAGER RD
Mailing Address - Street 2:
Mailing Address - City:LIVE OAK
Mailing Address - State:CA
Mailing Address - Zip Code:95953-9741
Mailing Address - Country:US
Mailing Address - Phone:530-674-2100
Mailing Address - Fax:
Practice Address - Street 1:348 MARKET ST
Practice Address - Street 2:SUITE B
Practice Address - City:COLUSA
Practice Address - State:CA
Practice Address - Zip Code:95932-2422
Practice Address - Country:US
Practice Address - Phone:530-458-2300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-23
Last Update Date:2008-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA70328208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CARHM08912FMedicaid