Healthcare Provider Details

I. General information

NPI: 1831792647
Provider Name (Legal Business Name): KIRAN JUDGE NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KIRANJIT SIDHU

II. Dates (important events)

Enumeration Date: 11/17/2020
Last Update Date: 12/04/2025
Certification Date: 12/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2720 LOW CT
FAIRFIELD CA
94534-9771
US

IV. Provider business mailing address

PO BOX 255228
SACRAMENTO CA
95865-5228
US

V. Phone/Fax

Practice location:
  • Phone: 707-427-4900
  • Fax: 707-436-2509
Mailing address:
  • Phone: 800-470-0071
  • Fax: 916-854-6769

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number95015940
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: