Healthcare Provider Details

I. General information

NPI: 1164872370
Provider Name (Legal Business Name): JASMINE KAUR VIRK M.D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/18/2016
Last Update Date: 05/08/2023
Certification Date: 05/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

441 E CHOCOLATE AVE
HERSHEY PA
17033-1324
US

IV. Provider business mailing address

441 E CHOCOLATE AVE
HERSHEY PA
17033-1324
US

V. Phone/Fax

Practice location:
  • Phone: 717-533-7850
  • Fax: 717-533-8294
Mailing address:
  • Phone: 717-533-7850
  • Fax: 717-533-8294

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD479132
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number0101265894
License Number StateVA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: