Healthcare Provider Details

I. General information

NPI: 1184814758
Provider Name (Legal Business Name): KIRANJOT KAUR RANDHAWA D.O
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/30/2007
Last Update Date: 12/16/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

455 E COLUMBIA ST SUITE 201 & 6
LONG BEACH CA
90806-1620
US

IV. Provider business mailing address

2135 CRESCENT DR
SIGNAL HILL CA
90755-5622
US

V. Phone/Fax

Practice location:
  • Phone: 562-933-0400
  • Fax:
Mailing address:
  • Phone: 562-933-0494
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number2OA9915
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: