Healthcare Provider Details

I. General information

NPI: 1700394608
Provider Name (Legal Business Name): MANDEEP K SIDHU
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/14/2018
Last Update Date: 08/01/2025
Certification Date: 08/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7005 N MILBURN AVE
FRESNO CA
93722-2161
US

IV. Provider business mailing address

1649 VAN NESS AVE
FRESNO CA
93721-1128
US

V. Phone/Fax

Practice location:
  • Phone: 559-603-7300
  • Fax:
Mailing address:
  • Phone: 888-530-4415
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA179949
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: