Healthcare Provider Details

I. General information

NPI: 1912036658
Provider Name (Legal Business Name): GURUCHARAN SINGH KHALSA PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/05/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

428 HARRISON AVE STE 200
CLAREMONT CA
91711-4605
US

IV. Provider business mailing address

428 HARRISON AVE STE 200
CLAREMONT CA
91711-4605
US

V. Phone/Fax

Practice location:
  • Phone: 909-593-3798
  • Fax: 909-624-7002
Mailing address:
  • Phone: 909-593-3798
  • Fax: 909-624-7002

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPSY13226
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY13226
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License NumberPSY13226
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: