Healthcare Provider Details

I. General information

NPI: 1649246349
Provider Name (Legal Business Name): DEEPAL S SIDHU MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/23/2006
Last Update Date: 09/17/2025
Certification Date: 09/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 HOSPITAL PKWY
SAN JOSE CA
95119-1103
US

IV. Provider business mailing address

3212 WHITESAND DR
SAN JOSE CA
95148-3807
US

V. Phone/Fax

Practice location:
  • Phone: 408-972-6320
  • Fax:
Mailing address:
  • Phone: 408-834-5175
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number220323
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberC52294
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code207LC0200X
TaxonomyCritical Care Medicine (Anesthesiology) Physician
License Number220323
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: