Healthcare Provider Details

I. General information

NPI: 1063335164
Provider Name (Legal Business Name): NIMESH KISSUN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/04/2026
Last Update Date: 08/04/2026
Certification Date: 08/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27740 JEFFERSON AVE
TEMECULA CA
92590-2638
US

IV. Provider business mailing address

29248 OUTBACK LN
WINCHESTER CA
92596-6328
US

V. Phone/Fax

Practice location:
  • Phone: 951-252-8800
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: