MEDICARE: DR. SANDEEP K THAKKAR D.O.

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	2084N0400X	Neurology Physician	20A10840	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1740454586
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SANDEEP K THAKKAR D.O.

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	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/14/2008
Last Update Date	:	04/13/2026

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