Healthcare Provider Details

I. General information

NPI: 1730585910
Provider Name (Legal Business Name): ARMINDER KAUR DOM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/14/2014
Last Update Date: 11/14/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11100 APACHE AVE NE
ALBUQUERQUE NM
87112-3208
US

IV. Provider business mailing address

11100 APACHE AVE NE
ALBUQUERQUE NM
87112-3208
US

V. Phone/Fax

Practice location:
  • Phone: 505-720-5011
  • Fax:
Mailing address:
  • Phone: 505-720-5011
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number478RX2
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: