Healthcare Provider Details

I. General information

NPI: 1992614234
Provider Name (Legal Business Name): ISHJOT KAUR LVN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/03/2026
Last Update Date: 09/03/2026
Certification Date: 09/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4001 LONE TREE WAY
ANTIOCH CA
94509-6232
US

IV. Provider business mailing address

3364 FEATHER RD
MANTECA CA
95337-7044
US

V. Phone/Fax

Practice location:
  • Phone: 925-754-0470
  • Fax:
Mailing address:
  • Phone: 209-834-4071
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number739662
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: