Healthcare Provider Details

I. General information

NPI: 1588875512
Provider Name (Legal Business Name): SAHDEV SAHARAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2007
Last Update Date: 03/21/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

530 W EATON AVE STE 5
TRACY CA
95376-3400
US

IV. Provider business mailing address

3031 W MARCH LN STE 203
STOCKTON CA
95219-6568
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:
Title or Position:
Credential:
Phone: