Healthcare Provider Details

I. General information

NPI: 1699701094
Provider Name (Legal Business Name): UJJAL SANDHU MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/25/2006
Last Update Date: 11/30/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

116 HILLS PLZ
CHARLESTON WV
25387-2438
US

IV. Provider business mailing address

97 GREAT TEAYS BLVD STE 6
SCOTT DEPOT WV
25560-9816
US

V. Phone/Fax

Practice location:
  • Phone: 304-720-4466
  • Fax: 304-720-4821
Mailing address:
  • Phone: 304-757-6999
  • Fax: 304-757-3252

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number09449
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: