Healthcare Provider Details

I. General information

NPI: 1205452299
Provider Name (Legal Business Name): AMARDEEP SINGH CHHARAN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/25/2020
Last Update Date: 03/25/2026
Certification Date: 03/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18818 OUTER HWY 18
APPLE VALLEY CA
92307-2323
US

IV. Provider business mailing address

18818 OUTER HWY 18
APPLE VALLEY CA
92307-2323
US

V. Phone/Fax

Practice location:
  • Phone: 909-388-0900
  • Fax:
Mailing address:
  • Phone: 909-388-0900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0802X
TaxonomyAddiction Psychiatry Physician
License Number20A21045
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: