Individual
KEVIN SIDHU
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
12140 NEW YORK RANCH RD, JACKSON, CA 95642-9407
(209) 257-2400
Mailing address
2362 CAMBERWELL DR, SAINT LOUIS, MO 63131-2116
(209) 269-0451
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
036158817
IL
207P00000X
Emergency Medicine Physician
2019045209
MO
207Q00000X
Family Medicine Physician
20A15886
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1093165953
—
CA
Enumeration date
06/21/2016
Last updated
08/10/2023
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