Healthcare Provider Details

I. General information

NPI: 1891256566
Provider Name (Legal Business Name): SHAUNDEEP SEKHON
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2019
Last Update Date: 07/02/2023
Certification Date: 07/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

650 CHARLES E YOUNG DR S
LOS ANGELES CA
90095-2908
US

IV. Provider business mailing address

650 CHARLES E YOUNG DR S
LOS ANGELES CA
90095-2908
US

V. Phone/Fax

Practice location:
  • Phone: 310-206-6286
  • Fax:
Mailing address:
  • Phone: 310-206-6286
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number125.073763
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: