Basic Information
Provider Information
NPI: 1487823787
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: SAGOO
FirstName: DALJEET
MiddleName: SINGH
NamePrefix: DR.
NameSuffix:  
Credential: DO
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 340 DARDANELLI LN
Address2: STE 10
City: LOS GATOS
State: CA
PostalCode: 950321418
CountryCode: US
TelephoneNumber: 8582788300
FaxNumber: 8582781708
Practice Location
Address1: 7910 FROST ST
Address2: SUITE 200
City: SAN DIEGO
State: CA
PostalCode: 921232771
CountryCode: US
TelephoneNumber: 8582788300
FaxNumber: 8582781708
Other Information
ProviderEnumerationDate: 02/21/2008
LastUpdateDate: 08/18/2021
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 08/18/2021

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207X00000X20A10273CAY Allopathic & Osteopathic PhysiciansOrthopaedic Surgery 

No ID Information.


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