Healthcare Provider Details

I. General information

NPI: 1275306219
Provider Name (Legal Business Name): HARLEEN KAUR HUNDAL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: HARLEEN HARLEEN KAUR

II. Dates (important events)

Enumeration Date: 11/01/2023
Last Update Date: 07/29/2026
Certification Date: 07/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4605 STATE RD
DREXEL HILL PA
19026
US

IV. Provider business mailing address

50 N MIDDLETOWN ROAD APT 229
MEDIA PA
19063
US

V. Phone/Fax

Practice location:
  • Phone: 610-200-9200
  • Fax:
Mailing address:
  • Phone: 780-297-7755
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDS045947
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: