Healthcare Provider Details

I. General information

NPI: 1174473185
Provider Name (Legal Business Name): SUPREET SINGH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/29/2026
Last Update Date: 01/29/2026
Certification Date: 01/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5221 N 18TH DR
PHOENIX AZ
85015-3037
US

IV. Provider business mailing address

5221 N 18TH DR
PHOENIX AZ
85015-3037
US

V. Phone/Fax

Practice location:
  • Phone: 602-497-9166
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberLAC-012230
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: