Healthcare Provider Details

I. General information

NPI: 1639153372
Provider Name (Legal Business Name): SANJAY SAHGAL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/06/2005
Last Update Date: 04/26/2021
Certification Date: 04/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4441 E KINGS CANYON RD
FRESNO CA
93702-3604
US

IV. Provider business mailing address

PO BOX 512717
LOS ANGELES CA
90051-0717
US

V. Phone/Fax

Practice location:
  • Phone: 559-600-9059
  • Fax:
Mailing address:
  • Phone: 310-967-1884
  • Fax: 310-967-1744

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License NumberG81077
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code2084F0202X
TaxonomyForensic Psychiatry Physician
License NumberG81077
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: