Healthcare Provider Details

I. General information

NPI: 1003016452
Provider Name (Legal Business Name): KAMALDEEP SINGH D.C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/24/2007
Last Update Date: 07/30/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

320 SUPERIOR AVE SUITE 350
NEWPORT BEACH CA
92663-2716
US

IV. Provider business mailing address

320 SUPERIOR AVE SUITE 350
NEWPORT BEACH CA
92663-2716
US

V. Phone/Fax

Practice location:
  • Phone: 949-548-1188
  • Fax: 949-548-1177
Mailing address:
  • Phone: 949-548-1188
  • Fax: 949-548-1177

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License Number30624
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: