Healthcare Provider Details

I. General information

NPI: 1942966916
Provider Name (Legal Business Name): JASHANDEEP KAUR DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/13/2021
Last Update Date: 11/13/2021
Certification Date: 11/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1095 HERNDON AVE STE 102
CLOVIS CA
93612-0504
US

IV. Provider business mailing address

3238 POE AVE
CLOVIS CA
93619-5017
US

V. Phone/Fax

Practice location:
  • Phone: 559-326-5272
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDDS107130
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: