MEDICARE: SANDEEP THAKKAR DO A PROFESSIONAL CORPORATION

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM2500X	Medical Specialty Clinic/Center

General Provider Information

NPI Number	:	1568150662
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SANDEEP THAKKAR DO A PROFESSIONAL CORPORATION

Provider Business Mailing Address
First Line	:	15775 LAGUNA CANYON RD STE 190
Second Line	:
City	:	IRVINE
State	:	CA
Zip	:	92618-7707
Country	:	US
Telephone Number	:	714-602-9891
Fax Number	:	714-912-4181

Provider Business Practice Location Address
First Line	:	15775 LAGUNA CANYON RD STE 190
Second Line	:
City	:	IRVINE
State	:	CA
Zip	:	92618-7707
Country	:	US
Telephone Number	:	714-602-9891
Fax Number	:	714-912-4181

Authorized Official
Title or Position	:	CREDENTIALING MANAGER
Name	:	LAURIE BOOKER
Credential	:
Telephone Number	:	951-681-8693

Provider Enumeration Date	:	04/26/2023
Last Update Date	:	04/01/2026

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