Individual provider Active NPI

Kirandeep Sandhu

  • Psychiatry Physician
  • Pomona, CA
National Provider Identifier
1013352426
Registry record updated Jun 10, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
License
A153504 Issued in CA
Practice address
2008 N Garey Ave
Pomona, CA 91767-2722
Phone
(909) 623-6131
NPI assigned
Apr 30, 2013
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 10, 2019

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X
Psychiatry Physician 2084P0800X A153504 CA Primary

Addresses

Primary practice location

2008 N Garey Ave
Pomona, CA 91767-2722

Mailing address

2008 N Garey Ave
Pomona, CA 91767-2722
Phone (909) 623-6131

Other practice location 1

450 Clarkson Ave
Box 1262
Brooklyn, NY 11203-2012
Phone (718) 270-8867

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20191217003142 CA Practitioner - Psychiatry 0941634349 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
A153504CAMDPsychiatry Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Tri-City Mental Health Authority CurrentSince Oct 22, 2019 Accepting new patients
Tri-City Mental Health Center PastSince Oct 22, 2019 Accepting new patients

Locations

2008 N Garey Ave
Pomona, CA 91767
Phone (909) 242-7640

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1367280000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1560124800000",
    "number": "1013352426",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2008 N GAREY AVE",
            "city": "POMONA",
            "state": "CA",
            "postal_code": "917672722",
            "telephone_number": "909-623-6131"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2008 N GAREY AVE",
            "city": "POMONA",
            "state": "CA",
            "postal_code": "917672722",
            "telephone_number": "909-623-6131"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "450 Clarkson Ave",
            "address_2": "Box 1262",
            "address_purpose": "LOCATION",
            "city": "Brooklyn",
            "state": "NY",
            "postal_code": "112032012",
            "country_code": "US",
            "telephone_number": "718-270-8867",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SANDHU",
        "first_name": "KIRANDEEP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-04-30",
        "last_updated": "2019-06-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "CA",
            "license": "A153504",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Pomona, CA

Sources for this page

Verify at the official NPI Registry.