Healthcare Provider Details

I. General information

NPI: 1184618399
Provider Name (Legal Business Name): VIRENDER K SACHDEVA M.D.01/19/1949
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 09/01/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

175 N JACKSON AVE
SAN JOSE CA
95116-1909
US

IV. Provider business mailing address

175 N JACKSON AVE
SAN JOSE CA
95116-1909
US

V. Phone/Fax

Practice location:
  • Phone: 408-926-1340
  • Fax: 408-926-1779
Mailing address:
  • Phone: 408-926-1340
  • Fax: 408-926-1779

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA35415
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: