Healthcare Provider Details

I. General information

NPI: 1871024976
Provider Name (Legal Business Name): JASKIRAT SINGH SIDHU MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/21/2017
Last Update Date: 08/26/2026
Certification Date: 08/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13215 SE MILL PLAIN BLVD STE C81101
VANCOUVER WA
98684-6991
US

IV. Provider business mailing address

13215 SE MILL PLAIN BLVD STE C81101
VANCOUVER WA
98684-6991
US

V. Phone/Fax

Practice location:
  • Phone: 253-385-3710
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberMD61420936
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberMD215892
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: