Healthcare Provider Details

I. General information

NPI: 1063587616
Provider Name (Legal Business Name): ARVINDER KAUR THIARA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ARVINDER KAUR M.D.

II. Dates (important events)

Enumeration Date: 11/21/2006
Last Update Date: 10/22/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 W LODI AVE SUITE P
LODI CA
95242-3000
US

IV. Provider business mailing address

600 COFFEE RD
MODESTO CA
95355-4201
US

V. Phone/Fax

Practice location:
  • Phone: 209-366-1990
  • Fax: 209-473-9256
Mailing address:
  • Phone: 209-524-1211
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA97774
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: