Provider Demographics
NPI:1174784300
Name:SIDHU, JAISIMARAN K (MD)
Entity type:Individual
Prefix:
First Name:JAISIMARAN
Middle Name:K
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 1:590 W PUTNAM AVE
Mailing Address - Street 2:SUITE # 9
Mailing Address - City:PORTERVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:93257-3257
Mailing Address - Country:US
Mailing Address - Phone:559-784-4807
Mailing Address - Fax:559-781-4523
Practice Address - Street 1:590 W PUTNAM AVE
Practice Address - Street 2:SUITE # 9
Practice Address - City:PORTERVILLE
Practice Address - State:CA
Practice Address - Zip Code:93257-3257
Practice Address - Country:US
Practice Address - Phone:559-784-4807
Practice Address - Fax:559-781-4523
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-20
Last Update Date:2013-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0116018858207Q00000X
CAA106157207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine