Healthcare Provider Details

I. General information

NPI: 1679436836
Provider Name (Legal Business Name): MANINDER KAUR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/04/2025
Last Update Date: 08/30/2026
Certification Date: 08/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3109 VISTA LN
FAIRVIEW CA
94541-5569
US

IV. Provider business mailing address

3109 VISTA LN
FAIRVIEW CA
94541-5569
US

V. Phone/Fax

Practice location:
  • Phone: 510-876-7118
  • Fax:
Mailing address:
  • Phone: 510-255-1544
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number95159704
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: