Healthcare Provider Details

I. General information

NPI: 1245513167
Provider Name (Legal Business Name): MS. KIRIN KAUR BASUTA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/27/2011
Last Update Date: 02/11/2022
Certification Date: 07/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

SOCIAL MEDICINE 25975 S. NORMANDIE AVE
HARBOR CITY CA
90710
US

IV. Provider business mailing address

25975 NORMANDIE AVE DEPT OF
HARBOR CITY CA
90710-3416
US

V. Phone/Fax

Practice location:
  • Phone: 424-251-7794
  • Fax:
Mailing address:
  • Phone: 424-251-7794
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW80385
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: