Healthcare Provider Details

I. General information

NPI: 1457947822
Provider Name (Legal Business Name): SAMIR SINGH SEKHON
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/18/2020
Last Update Date: 06/19/2023
Certification Date: 06/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1356 RIDDER PARK DR
SAN JOSE CA
95131-2313
US

IV. Provider business mailing address

174 IRIS BLOSSOM CT
SAN JOSE CA
95123-2233
US

V. Phone/Fax

Practice location:
  • Phone: 408-842-7138
  • Fax:
Mailing address:
  • Phone: 408-391-0195
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: