Healthcare Provider Details

I. General information

NPI: 1760800601
Provider Name (Legal Business Name): SANBIR SINGH SIDHU M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2014
Last Update Date: 08/07/2020
Certification Date: 08/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8510 BALBOA BLVD STE 150
NORTHRIDGE CA
91325-5810
US

IV. Provider business mailing address

1878 CAMINITO DEL CIELO
GLENDALE CA
91208-3049
US

V. Phone/Fax

Practice location:
  • Phone: 818-654-3400
  • Fax:
Mailing address:
  • Phone: 216-224-4660
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number169699
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: