Healthcare Provider Details

I. General information

NPI: 1952383614
Provider Name (Legal Business Name): KULDEEP SINGH SIDHU M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/17/2005
Last Update Date: 02/08/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1450 BESSIE AVE
TRACY CA
95376-3417
US

IV. Provider business mailing address

1450 BESSIE AVE
TRACY CA
95376-3417
US

V. Phone/Fax

Practice location:
  • Phone: 209-835-4888
  • Fax: 209-835-6424
Mailing address:
  • Phone: 209-835-4888
  • Fax: 209-835-6424

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberA38277
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: