Healthcare Provider Details

I. General information

NPI: 1164972162
Provider Name (Legal Business Name): JASVINDER KAUR PH.D, RDN, RD, MS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/13/2016
Last Update Date: 10/13/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

34408 ALBERTA TER
FREMONT CA
94555-2906
US

IV. Provider business mailing address

34408 ALBERTA TER
FREMONT CA
94555-2906
US

V. Phone/Fax

Practice location:
  • Phone: 510-796-4656
  • Fax:
Mailing address:
  • Phone: 510-796-4656
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number849118
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: