Basic Information
Provider Information
NPI: 1730146937
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: DANG
FirstName: SANDEEP
MiddleName: SINGH
NamePrefix: DR.
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 4225 EXECUTIVE SQ STE 450
Address2:  
City: LA JOLLA
State: CA
PostalCode: 920378411
CountryCode: US
TelephoneNumber: 8588108000
FaxNumber:  
Practice Location
Address1: 11100 WARNER AVE STE 218
Address2:  
City: FOUNTAIN VALLEY
State: CA
PostalCode: 927087511
CountryCode: US
TelephoneNumber: 7146419696
FaxNumber: 7146411211
Other Information
ProviderEnumerationDate: 05/01/2006
LastUpdateDate: 02/02/2021
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 02/02/2021

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207RN0300XA79958CAY Allopathic & Osteopathic PhysiciansInternal MedicineNephrology

No ID Information.


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