Healthcare Provider Details

I. General information

NPI: 1194664045
Provider Name (Legal Business Name): SUKHWINDER KAUR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/26/2026
Last Update Date: 03/31/2026
Certification Date: 03/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1109 N CALIFORNIA ST
STOCKTON CA
95202-1537
US

IV. Provider business mailing address

1850 BASIL DR
MANTECA CA
95336-8537
US

V. Phone/Fax

Practice location:
  • Phone: 209-875-8769
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: