Basic Information
| Provider Information | |||||||||
| NPI: | 1073164497 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SANDHU | ||||||||
| FirstName: | SMANPREET | ||||||||
| MiddleName: | K | ||||||||
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| Mailing Information | |||||||||
| Address1: | 33 W RAHN RD | ||||||||
| Address2: | |||||||||
| City: | DAYTON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 454292219 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9374338990 | ||||||||
| FaxNumber: | 9374338691 | ||||||||
| Practice Location | |||||||||
| Address1: | 33 W RAHN RD | ||||||||
| Address2: | |||||||||
| City: | DAYTON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 454292219 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9374338990 | ||||||||
| FaxNumber: | 9374338691 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/26/2019 | ||||||||
| LastUpdateDate: | 09/26/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | 50.006150RX | OH | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
No ID Information.