Healthcare Provider Details

I. General information

NPI: 1851953186
Provider Name (Legal Business Name): SUKHDEEP KAUR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/08/2019
Last Update Date: 07/08/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 S MAIN ST
CORONA CA
92882-3402
US

IV. Provider business mailing address

8358 PECAN AVE
RANCHO CUCAMONGA CA
91739-9269
US

V. Phone/Fax

Practice location:
  • Phone: 951-735-2700
  • Fax:
Mailing address:
  • Phone: 909-775-4851
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA56954
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: