# SANDEEP K. THAKKAR, D.O.

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1578900809
- **Authorized official:** SANDEEP K THAKKAR D.O. (OWNER)
- **Authorized official phone:** (562) 233-9109

## Contact information

- **Practice address:** 510 SUPERIOR AVE, STE. 200A, NEWPORT BEACH, CA 92663-3663
- **Practice address phone:** (562) 233-9109
- **Practice address fax:** (949) 650-4585
- **Mailing address:** 510 SUPERIOR AVE, STE. 200A, NEWPORT BEACH, CA 92663-3663
- **Mailing address phone:** (562) 233-9109

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 2084N0008X | Neuromuscular Medicine (Psychiatry & Neurology) Physician | 20A10840 | CA | Yes |

## Other

- **Enumeration date:** 05/28/2013
- **Last updated:** 05/28/2013