Healthcare Provider Details

I. General information

NPI: 1760558332
Provider Name (Legal Business Name): JAGDEEP KAUR MEHROK M.D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/27/2006
Last Update Date: 12/06/2021
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16300 SAND CANYON AVE STE 311
IRVINE CA
92618-3703
US

IV. Provider business mailing address

510 SUPERIOR AVE STE 200B
NEWPORT BEACH CA
92663-3665
US

V. Phone/Fax

Practice location:
  • Phone: 949-791-3101
  • Fax:
Mailing address:
  • Phone: 949-791-3001
  • Fax: 949-791-3096

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA88603
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: