Healthcare Provider Details

I. General information

NPI: 1245694892
Provider Name (Legal Business Name): KIRANDEEP KAUR SUMRA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/11/2016
Last Update Date: 03/14/2024
Certification Date: 03/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 W CARSON ST
TORRANCE CA
90502-2004
US

IV. Provider business mailing address

11054 OXNARD ST
NORTH HOLLYWOOD CA
91606-4930
US

V. Phone/Fax

Practice location:
  • Phone: 310-222-3501
  • Fax:
Mailing address:
  • Phone: 818-516-1285
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberA155874
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: