Healthcare Provider Details

I. General information

NPI: 1417682808
Provider Name (Legal Business Name): POONAM KAUR DEHAL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2022
Last Update Date: 08/02/2026
Certification Date: 08/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5201 GREAT AMERICA PKWY
SANTA CLARA CA
95054-1122
US

IV. Provider business mailing address

87 SAINT ANDREWS ST
HAYWARD CA
94544-7333
US

V. Phone/Fax

Practice location:
  • Phone: 510-990-9530
  • Fax:
Mailing address:
  • Phone: 510-990-9530
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number160538
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: