Healthcare Provider Details

I. General information

NPI: 1427288588
Provider Name (Legal Business Name): GUNJEET K KALA AHLUWALIA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/22/2009
Last Update Date: 05/18/2020
Certification Date: 05/18/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

220 LAGUNA RD STE 5
FULLERTON CA
92835-2523
US

IV. Provider business mailing address

220 LAGUNA RD STE 5
FULLERTON CA
92835-2523
US

V. Phone/Fax

Practice location:
  • Phone: 714-879-2980
  • Fax:
Mailing address:
  • Phone: 714-879-2980
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA117446
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number04-34474
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: