Healthcare Provider Details

I. General information

NPI: 1366197600
Provider Name (Legal Business Name): RUPINDER KAUR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/15/2022
Last Update Date: 05/02/2022
Certification Date: 05/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12586 AVENUE 408
OROSI CA
93647-9454
US

IV. Provider business mailing address

305 E CENTER AVE
VISALIA CA
93291-6331
US

V. Phone/Fax

Practice location:
  • Phone: 877-960-3426
  • Fax:
Mailing address:
  • Phone: 559-419-3308
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number107277
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: