Healthcare Provider Details

I. General information

NPI: 1245793215
Provider Name (Legal Business Name): PRABDEEP SEKHON
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/08/2019
Last Update Date: 10/09/2023
Certification Date: 10/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

151 E AVENUE J STE A
LANCASTER CA
93535-3516
US

IV. Provider business mailing address

151 E AVENUE J STE A
LANCASTER CA
93535-3516
US

V. Phone/Fax

Practice location:
  • Phone: 661-942-1179
  • Fax:
Mailing address:
  • Phone: 818-588-5362
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number105183
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: