Healthcare Provider Details

I. General information

NPI: 1265886816
Provider Name (Legal Business Name): GAGAN KAUR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/20/2016
Last Update Date: 07/03/2024
Certification Date: 07/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8974 E ANN WAY
SCOTTSDALE AZ
85260-5064
US

IV. Provider business mailing address

8974 E ANN WAY
SCOTTSDALE AZ
85260-5064
US

V. Phone/Fax

Practice location:
  • Phone: 602-538-5507
  • Fax:
Mailing address:
  • Phone: 602-538-5507
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number70872
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: