Provider Demographics
NPI:1861426470
Name:KHANGURA, SUKHDEV SINGH (MD)
Entity type:Individual
Prefix:
First Name:SUKHDEV
Middle Name:SINGH
Last Name:KHANGURA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3609 MISSION AVE #H
Mailing Address - Street 2:SUITE H
Mailing Address - City:CARMICHAEL
Mailing Address - State:CA
Mailing Address - Zip Code:95608-2955
Mailing Address - Country:US
Mailing Address - Phone:916-483-5589
Mailing Address - Fax:916-486-1878
Practice Address - Street 1:3609 MISSION AVE #H
Practice Address - Street 2:SUITE H
Practice Address - City:CARMICHAEL
Practice Address - State:CA
Practice Address - Zip Code:95608
Practice Address - Country:US
Practice Address - Phone:916-483-5589
Practice Address - Fax:916-486-1878
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA5017Z207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0682925Medicaid
F37641Medicare UPIN
00A501720Medicare ID - Type Unspecified