Provider Demographics
NPI:1033671672
Name:MANN, SANDEEP SINGH (MD)
Entity type:Individual
Prefix:
First Name:SANDEEP
Middle Name:SINGH
Last Name:MANN
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 1:2216 N CALIFORNIA ST STE A
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95204-5533
Mailing Address - Country:US
Mailing Address - Phone:209-851-2065
Mailing Address - Fax:209-292-8910
Practice Address - Street 1:2216 N CALIFORNIA ST STE A
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95204-5533
Practice Address - Country:US
Practice Address - Phone:209-851-2065
Practice Address - Fax:209-292-8910
Is Sole Proprietor?:No
Enumeration Date:2019-04-02
Last Update Date:2024-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA18064207Q00000X, 207QA0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine