Healthcare Provider Details

I. General information

NPI: 1477059491
Provider Name (Legal Business Name): HARDEEP KOUR MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/30/2018
Last Update Date: 09/15/2021
Certification Date: 09/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4923 ESGUERRA TER
FREMONT CA
94555-2677
US

IV. Provider business mailing address

4923 ESGUERRA TER
FREMONT CA
94555-2677
US

V. Phone/Fax

Practice location:
  • Phone: 408-507-2367
  • Fax:
Mailing address:
  • Phone: 408-507-2367
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number174408
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: