Basic Information
| Provider Information | |||||||||
| NPI: | 1215318753 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CHADHA | ||||||||
| FirstName: | SANDEEP | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3400 DATA DR | ||||||||
| Address2: | ATTN CREDENTIALING/PAYER ENROLLMENT | ||||||||
| City: | RANCHO CORDOVA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 956707956 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 18460 ROSCOE BLVD FL 3 | ||||||||
| Address2: | |||||||||
| City: | NORTHRIDGE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 913254107 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8188855480 | ||||||||
| FaxNumber: | 8189931917 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/10/2015 | ||||||||
| LastUpdateDate: | 05/15/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 05/15/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | A153507 | CA | Y | Allopathic & Osteopathic Physicians | Family Medicine | 390200000X | 0116028367 | VA | N | Student, Health Care | Student in an Organized Health Care Education/Training Program |
No ID Information.