Healthcare Provider Details

I. General information

NPI: 1417979907
Provider Name (Legal Business Name): JASJEET KAUR MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/24/2006
Last Update Date: 01/11/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20100 N 51ST AVE SUITE F-635
GLENDALE AZ
85308-5125
US

IV. Provider business mailing address

20100 N 51ST AVE SUITE F-635
GLENDALE AZ
85308-5125
US

V. Phone/Fax

Practice location:
  • Phone: 623-266-7858
  • Fax: 623-444-9810
Mailing address:
  • Phone: 623-266-7858
  • Fax: 623-444-9810

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number002555
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number36320
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: