Healthcare Provider Details

I. General information

NPI: 1508872425
Provider Name (Legal Business Name): LAKHJIT S SANDHU MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/31/2006
Last Update Date: 08/31/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7215 N FRESNO ST STE 103
FRESNO CA
93720-2969
US

IV. Provider business mailing address

7215 N FRESNO ST STE 103
FRESNO CA
93720-2969
US

V. Phone/Fax

Practice location:
  • Phone: 559-438-1111
  • Fax: 559-438-4002
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number00A454840
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: