Healthcare Provider Details

I. General information

NPI: 1588540280
Provider Name (Legal Business Name): MR. CHARANJIT SINGH SANDHU
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/15/2025
Last Update Date: 08/15/2025
Certification Date: 08/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9820 SIERRA AVE STE D
FONTANA CA
92335-6778
US

IV. Provider business mailing address

9820 SIERRA AVE STE D
FONTANA CA
92335-6778
US

V. Phone/Fax

Practice location:
  • Phone: 909-240-0271
  • Fax:
Mailing address:
  • Phone: 909-240-0271
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number95088F4
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number8LVP144
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number9GFL590
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: