Provider Demographics
NPI:1902885924
Name:SIDHU, HARJOT (MD)
Entity Type:Individual
Prefix:
First Name:HARJOT
Middle Name:
Last Name:SIDHU
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1901 N CALIFORNIA ST
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95204-6005
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1901 N. CALIFORNIA ST.
Practice Address - Street 2:DIGNITY HEALTH CARE / SJMG
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95204
Practice Address - Country:US
Practice Address - Phone:209-946-6800
Practice Address - Fax:209-946-6805
Is Sole Proprietor?:No
Enumeration Date:2006-01-10
Last Update Date:2023-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN47457207R00000X, 207RG0100X
WI38593207RG0100X
CAC54946207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN040933200Medicaid
MNNA2951042895OtherPREFFERED ONE
IA2450023OtherMEDICAID
MN2316540OtherAMERICAS PPO
41084933956001C005OtherCHAMPUS
MN132592OtherUCARE
MN2900368OtherMEDICA
MN944S8SIOtherBCBS
MNHP49006OtherHEALTH PARTNERS
MNHP49006OtherHEALTH PARTNERS
MN040933200Medicaid
MN100000620Medicare Oscar/Certification