Basic Information
Provider Information
NPI: 1255606414
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: SANDHU
FirstName: GURVEEN
MiddleName:  
NamePrefix: MISS
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 5767 W CENTURY BLVD STE 400
Address2:  
City: LOS ANGELES
State: CA
PostalCode: 900455631
CountryCode: US
TelephoneNumber: 3103018771
FaxNumber: 3103018751
Practice Location
Address1: 3500 LOMITA BLVD STE 300
Address2:  
City: TORRANCE
State: CA
PostalCode: 905055038
CountryCode: US
TelephoneNumber: 3102570028
FaxNumber: 3102570031
Other Information
ProviderEnumerationDate: 03/20/2012
LastUpdateDate: 12/04/2020
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 12/04/2020

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
208M00000XA128527CAN Allopathic & Osteopathic PhysiciansHospitalist 
390200000X  N Student, Health CareStudent in an Organized Health Care Education/Training Program 
207R00000XA128527CAY Allopathic & Osteopathic PhysiciansInternal Medicine 

No ID Information.


Home