Organization
SANDEEP K. THAKKAR, D.O.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SANDEEP K THAKKAR D.O. (OWNER)
(562) 233-9109
Entity
Organization
Contact information
Practice address
510 SUPERIOR AVE, STE. 200A, NEWPORT BEACH, CA 92663-3663
(562) 233-9109
(949) 650-4585
Mailing address
510 SUPERIOR AVE, STE. 200A, NEWPORT BEACH, CA 92663-3663
(562) 233-9109
Taxonomy
Speciality
Code
Description
License number
State
2084N0008X
Neuromuscular Medicine (Psychiatry & Neurology) Physician
Primary
20A10840
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
20A10840
PTAN GX448A
CA
Enumeration date
05/28/2013
Last updated
05/28/2013
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