Healthcare Provider Details

I. General information

NPI: 1114681269
Provider Name (Legal Business Name): PREMIER ALLERGY ASTHMA AND IMMUNOLOGY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/25/2021
Last Update Date: 11/18/2021
Certification Date: 11/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8575 E PRINCESS DR STE 111
SCOTTSDALE AZ
85255-5437
US

IV. Provider business mailing address

8575 E PRINCESS DR STE 111
SCOTTSDALE AZ
85255-5437
US

V. Phone/Fax

Practice location:
  • Phone: 516-410-0698
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RA0201X
TaxonomyAllergy & Immunology (Internal Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: KIRANJIT KAUR KHALSA
Title or Position: PHYSICIAN
Credential: MD
Phone: 516-410-0698