Healthcare Provider Details

I. General information

NPI: 1609565209
Provider Name (Legal Business Name): SIMRUN BAL DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: SIMRUN SANDHU

II. Dates (important events)

Enumeration Date: 05/01/2023
Last Update Date: 01/26/2026
Certification Date: 01/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15827 LOS GATOS BLVD STE B
LOS GATOS CA
95032-3300
US

IV. Provider business mailing address

6711 S SEPULVEDA BLVD APT 303
LOS ANGELES CA
90045-2783
US

V. Phone/Fax

Practice location:
  • Phone: 408-356-4900
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number111643
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: