Healthcare Provider Details

I. General information

NPI: 1154243376
Provider Name (Legal Business Name): SUKHDEEP BAINS NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/28/2026
Last Update Date: 07/28/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 S WINCHESTER BLVD # 216
SAN JOSE CA
95128-3901
US

IV. Provider business mailing address

1224 BLACKSMITH DR
GILROY CA
95020-8100
US

V. Phone/Fax

Practice location:
  • Phone: 800-825-8556
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number95040441
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: