Provider Demographics
NPI:1396246229
Name:SIDHU, ANGADPREET SINGH (MEDICAL STUDENT)
Entity type:Individual
Prefix:
First Name:ANGADPREET
Middle Name:SINGH
Last Name:SIDHU
Suffix:
Gender:M
Credentials:MEDICAL STUDENT
Other - Prefix:
Other - First Name:PREET
Other - Middle Name:SINGH
Other - Last Name:SIDHU
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1490 HEATHERFIELD WAY
Mailing Address - Street 2:
Mailing Address - City:TRACY
Mailing Address - State:CA
Mailing Address - Zip Code:95376-5391
Mailing Address - Country:US
Mailing Address - Phone:925-963-1357
Mailing Address - Fax:
Practice Address - Street 1:1490 HEATHERFIELD WAY
Practice Address - Street 2:
Practice Address - City:TRACY
Practice Address - State:CA
Practice Address - Zip Code:95376-5391
Practice Address - Country:US
Practice Address - Phone:925-963-1357
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-26
Last Update Date:2023-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA21407207P00000X
CA20A21407207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine