Healthcare Provider Details

I. General information

NPI: 1043849078
Provider Name (Legal Business Name): SIDDHARTH BHARGAVA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/02/2020
Last Update Date: 05/30/2025
Certification Date: 05/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

555 N 13TH AVE
UPLAND CA
91786-4904
US

IV. Provider business mailing address

PO BOX 7412011
CHICAGO IL
60674-2011
US

V. Phone/Fax

Practice location:
  • Phone: 800-345-8979
  • Fax: 909-949-3967
Mailing address:
  • Phone: 314-362-3937
  • Fax: 314-362-3725

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207WX0009X
TaxonomyGlaucoma Specialist (Ophthalmology) Physician
License Number2024011050
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberA202244
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: