Healthcare Provider Details

I. General information

NPI: 1972214955
Provider Name (Legal Business Name): RAJDEEP KAUR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/09/2022
Last Update Date: 01/21/2025
Certification Date: 01/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

255 W BULLARD AVE STE 106
CLOVIS CA
93612-0861
US

IV. Provider business mailing address

6143 W GOUX AVE
FRESNO CA
93722-8531
US

V. Phone/Fax

Practice location:
  • Phone: 559-298-3384
  • Fax:
Mailing address:
  • Phone: 559-753-6949
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number108419
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: