Healthcare Provider Details

I. General information

NPI: 1467682260
Provider Name (Legal Business Name): JAGDEEP KAUR MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/15/2009
Last Update Date: 07/17/2024
Certification Date: 07/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8120 TIMBERLAKE WAY STE 210B
SACRAMENTO CA
95823-5414
US

IV. Provider business mailing address

8120 TIMBERLAKE WAY STE 210B
SACRAMENTO CA
95823-5414
US

V. Phone/Fax

Practice location:
  • Phone: 916-917-7316
  • Fax: 866-481-8756
Mailing address:
  • Phone: 916-917-7316
  • Fax: 866-481-8756

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084A0401X
TaxonomyAddiction Medicine (Psychiatry & Neurology) Physician
License NumberC170263
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code2084P0802X
TaxonomyAddiction Psychiatry Physician
License NumberC170263
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: