Healthcare Provider Details

I. General information

NPI: 1952582199
Provider Name (Legal Business Name): RANDEEP SINGH SANGHA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/15/2007
Last Update Date: 11/15/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4501 X ST SUITE 3019
SACRAMENTO CA
95817-2229
US

IV. Provider business mailing address

4501 X ST SUITE 3019
SACRAMENTO CA
95817-2229
US

V. Phone/Fax

Practice location:
  • Phone: 916-734-0517
  • Fax: 916-734-7946
Mailing address:
  • Phone: 916-734-0517
  • Fax: 916-734-7946

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License NumberA102057
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: