Healthcare Provider Details

I. General information

NPI: 1992497408
Provider Name (Legal Business Name): GAGAN KAUR KUNDI DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: GAGAN KAUR PANESAR

II. Dates (important events)

Enumeration Date: 05/23/2023
Last Update Date: 03/10/2026
Certification Date: 03/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6161 VAN BUREN BLVD STE 103
RIVERSIDE CA
92503-7603
US

IV. Provider business mailing address

6161 VAN BUREN BLVD STE 103
RIVERSIDE CA
92503-7603
US

V. Phone/Fax

Practice location:
  • Phone: 951-261-5277
  • Fax:
Mailing address:
  • Phone: 951-261-5277
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number108790
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: