Basic Information
Provider Information | |||||||||
NPI: | 1063671840 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | SANDHU | ||||||||
FirstName: | JANBIR | ||||||||
MiddleName: | KAUR | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | MSW | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 2010 EL CAMINO REAL | ||||||||
Address2: | #623 | ||||||||
City: | SANTA CLARA | ||||||||
State: | CA | ||||||||
PostalCode: | 950504051 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 4085107512 | ||||||||
FaxNumber: |   | ||||||||
Practice Location | |||||||||
Address1: | 2011 LITTLE ORCHARD ST | ||||||||
Address2: |   | ||||||||
City: | SAN JOSE | ||||||||
State: | CA | ||||||||
PostalCode: | 951251031 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 4085107512 | ||||||||
FaxNumber: | 4082549960 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 06/05/2008 | ||||||||
LastUpdateDate: | 08/12/2016 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | RC60019291 | WA | N |   | Behavioral Health & Social Service Providers | Social Worker |   | 104100000X | 26885 | CA | N |   | Behavioral Health & Social Service Providers | Social Worker |   | 104100000X | 72753 | CA | Y |   | Behavioral Health & Social Service Providers | Social Worker |   |
No ID Information.