Healthcare Provider Details

I. General information

NPI: 1639734700
Provider Name (Legal Business Name): GAGANDEEP KAUR NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/04/2019
Last Update Date: 09/09/2026
Certification Date: 09/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2481 PACHECO ST
CONCORD CA
94520-2019
US

IV. Provider business mailing address

1650 S TOPAZ WAY
MERIDIAN ID
83642-4474
US

V. Phone/Fax

Practice location:
  • Phone: 925-680-8933
  • Fax: 925-680-7635
Mailing address:
  • Phone: 208-605-7070
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberAP61352928
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number95032422
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: