Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0221X | Pediatric Dentist | 104052 | CA |
NPI | 1063874709 |
---|---|
Provider Name | Harsheen Sidhu |
First Address | Rancho Cucamonga, CA 91737 |
Second Address | Corona, CA 92882-5274 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/03/2016 |
Last Update Date | 25/07/2019 |