Healthcare Provider Details

I. General information

NPI: 1336718949
Provider Name (Legal Business Name): JANNAT KAUR GREWAL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/18/2021
Last Update Date: 07/08/2026
Certification Date: 07/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9904 GOLD DUST DR
BAKERSFIELD CA
93311-3025
US

IV. Provider business mailing address

9904 GOLD DUST DR
BAKERSFIELD CA
93311-3025
US

V. Phone/Fax

Practice location:
  • Phone: 661-345-3779
  • Fax:
Mailing address:
  • Phone: 661-345-3779
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: