Provider Demographics
NPI:1306953724
Name:SANDHU, AJIT PAL SINGH (MD)
Entity type:Individual
Prefix:DR
First Name:AJIT
Middle Name:PAL SINGH
Last Name:SANDHU
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 1:680 MOWRY AVE
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94536-4113
Mailing Address - Country:US
Mailing Address - Phone:510-790-1511
Mailing Address - Fax:510-791-8820
Practice Address - Street 1:680 MOWRY AVE
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94536-4113
Practice Address - Country:US
Practice Address - Phone:510-790-1511
Practice Address - Fax:510-791-8820
Is Sole Proprietor?:No
Enumeration Date:2006-08-23
Last Update Date:2012-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA34658207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA110004070OtherRAILROAD MEDICARE #
CA00A346580Medicaid
CA00A346580OtherBLUE SHIELD OF CA PROV#
CA00A346580OtherBLUE SHIELD OF CA PROV#
CA00A346580Medicaid