Healthcare Provider Details

I. General information

NPI: 1316388028
Provider Name (Legal Business Name): SIMRAN KAUR THIARA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SIMRAN KAUR NAHAL MD

II. Dates (important events)

Enumeration Date: 07/10/2013
Last Update Date: 09/10/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1020 29TH ST STE 270
SACRAMENTO CA
95816-5173
US

IV. Provider business mailing address

1020 29TH ST STE 270
SACRAMENTO CA
95816-5173
US

V. Phone/Fax

Practice location:
  • Phone: 916-455-3700
  • Fax: 916-733-8232
Mailing address:
  • Phone: 916-455-3700
  • Fax: 916-733-8232

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License NumberA138782
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: