Healthcare Provider Details

I. General information

NPI: 1902760788
Provider Name (Legal Business Name): KIRANJIT KAUR KANG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/15/2025
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1220 ZANES DR
PLUMAS LAKE CA
95961-9090
US

IV. Provider business mailing address

3119 MONROE RD
YUBA CITY CA
95993-8867
US

V. Phone/Fax

Practice location:
  • Phone: 530-749-0690
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number230161521
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: