Healthcare Provider Details

I. General information

NPI: 1184978504
Provider Name (Legal Business Name): SUKHDEEP KAUR PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/07/2012
Last Update Date: 01/03/2022
Certification Date: 02/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2823 FRESNO ST
FRESNO CA
93721-1324
US

IV. Provider business mailing address

2823 FRESNO ST
FRESNO CA
93721-1324
US

V. Phone/Fax

Practice location:
  • Phone: 559-499-6440
  • Fax: 559-499-6441
Mailing address:
  • Phone: 559-443-2682
  • Fax: 559-443-2681

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number51533
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number51533
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: