# ANDREY IVANOVICH SIDORENKO

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** No

## Provider details

- **NPI number:** 1548576754
- **Gender:** Man
- **Credential:** PA-C, DMSC

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 363A00000X | Physician Assistant | 21131 | CA | Yes |

## Other

- **Enumeration date:** 08/25/2010
- **Last updated:** 06/30/2025

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | CA109622 | PREMIUM URGENT CARE GRP PTAN | CA |