Healthcare Provider Details

I. General information

NPI: 1396023032
Provider Name (Legal Business Name): JASPREET SIDHU DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/29/2011
Last Update Date: 09/26/2025
Certification Date: 09/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1901 N CALIFORNIA ST
STOCKTON CA
95204-6005
US

IV. Provider business mailing address

3400 DATA DR
RANCHO CORDOVA CA
95670-7956
US

V. Phone/Fax

Practice location:
  • Phone: 209-946-6800
  • Fax: 209-946-6805
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number20A15530
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: