Healthcare Provider Details

I. General information

NPI: 1083631626
Provider Name (Legal Business Name): SATWANT SIDHU MD MSPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/17/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7515 VAN NUYS BOULEVARD 5TH FLOOR
VAN NUYS CA
91405
US

IV. Provider business mailing address

7515 VAN NUYS BOULEVARD 5TH FLOOR
VAN NUYS CA
91405
US

V. Phone/Fax

Practice location:
  • Phone: 818-947-4026
  • Fax: 818-989-8850
Mailing address:
  • Phone: 818-947-4026
  • Fax: 818-989-8850

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License NumberA025138
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: