Healthcare Provider Details

I. General information

NPI: 1730420399
Provider Name (Legal Business Name): SANJEEV PURI D.O
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/07/2013
Last Update Date: 09/21/2025
Certification Date: 09/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6557 GREENLEAF AVE
WHITTIER CA
90601-4108
US

IV. Provider business mailing address

1820 FULLERTON AVE STE 260
CORONA CA
92881-3101
US

V. Phone/Fax

Practice location:
  • Phone: 562-698-0811
  • Fax:
Mailing address:
  • Phone: 951-356-4009
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number58.007264
License Number StateOH
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number15903
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: