Healthcare Provider Details

I. General information

NPI: 1811853021
Provider Name (Legal Business Name): KULWINDER GILL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/31/2025
Last Update Date: 12/31/2025
Certification Date: 12/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28031 S ALYCIA WAY
TRACY CA
95304-8177
US

IV. Provider business mailing address

28031 S ALYCIA WAY
TRACY CA
95304-8177
US

V. Phone/Fax

Practice location:
  • Phone: 510-415-1424
  • Fax:
Mailing address:
  • Phone: 510-415-1424
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95037064
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: