Healthcare Provider Details

I. General information

NPI: 1952806903
Provider Name (Legal Business Name): GAGANDEEP KAUR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2018
Last Update Date: 03/25/2025
Certification Date: 03/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

424 S 56TH ST STE 120
PHOENIX AZ
85034-2177
US

IV. Provider business mailing address

424 S 56TH ST STE 120
PHOENIX AZ
85034-2177
US

V. Phone/Fax

Practice location:
  • Phone: 602-685-5166
  • Fax: 480-478-8091
Mailing address:
  • Phone: 602-685-5211
  • Fax: 602-685-5028

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number72285
License Number StateAZ

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: