Healthcare Provider Details

I. General information

NPI: 1518880053
Provider Name (Legal Business Name): JASDEEP SIDHU
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/01/2026
Last Update Date: 08/04/2026
Certification Date: 08/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

581 W PUTNAM AVE
PORTERVILLE CA
93257-3260
US

IV. Provider business mailing address

581 W PUTNAM AVE
PORTERVILLE CA
93257-3260
US

V. Phone/Fax

Practice location:
  • Phone: 559-782-0298
  • Fax:
Mailing address:
  • Phone: 559-782-0298
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number113448
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: