Healthcare Provider Details

I. General information

NPI: 1275771917
Provider Name (Legal Business Name): DATAR S. SODHI, M.D.,INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/03/2009
Last Update Date: 12/22/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

741 S ORANGE AVE
WEST COVINA CA
91790-2662
US

IV. Provider business mailing address

741 S ORANGE AVE
WEST COVINA CA
91790-2662
US

V. Phone/Fax

Practice location:
  • Phone: 626-814-1177
  • Fax:
Mailing address:
  • Phone: 626-814-1177
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA34032
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License NumberA34032
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code207RS0012X
TaxonomySleep Medicine (Internal Medicine) Physician
License NumberA34032
License Number StateCA

VIII. Authorized Official

Name: DATAR SINGH SODHI
Title or Position: PRESIDENT
Credential: M.D.
Phone: 626-814-1177