Healthcare Provider Details

I. General information

NPI: 1740104637
Provider Name (Legal Business Name): MANDEEP S CHHOKAR
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/05/2026
Last Update Date: 08/05/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4610 X ST
SACRAMENTO CA
95817-2200
US

IV. Provider business mailing address

4610 X ST
SACRAMENTO CA
95817-2200
US

V. Phone/Fax

Practice location:
  • Phone: 760-518-8885
  • Fax:
Mailing address:
  • Phone: 760-518-8885
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: