Healthcare Provider Details

I. General information

NPI: 1174822902
Provider Name (Legal Business Name): SAHDEV SAHARAN, M.D., INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/18/2011
Last Update Date: 06/23/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2800 N CALIFORNIA ST SUITE 5
STOCKTON CA
95204-3757
US

IV. Provider business mailing address

2800 N CALIFORNIA ST SUITE 5
STOCKTON CA
95204-3757
US

V. Phone/Fax

Practice location:
  • Phone: 209-462-7246
  • Fax: 209-462-7247
Mailing address:
  • Phone: 209-462-7246
  • Fax: 209-462-7247

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License NumberA93889
License Number StateCA

VIII. Authorized Official

Name: DR. SAHDEV SAHARAN
Title or Position: PRESIDENT
Credential: M.D.
Phone: 209-462-7246