=====================================================
General NPI Number Information
=====================================================
NPI Number | 1164972162
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JASVINDER KAUR PH.D, RDN, RD, MS
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/13/2016
-----------------------------------------------------
Last Update Date | 10/13/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 34408 ALBERTA TER
-----------------------------------------------------
City | FREMONT
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94555-2906
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 510-796-4656
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 34408 ALBERTA TER
-----------------------------------------------------
City | FREMONT
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94555-2906
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 510-796-4656
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 133N00000X
-----------------------------------------------------
Taxonomy Name | Nutritionist
-----------------------------------------------------
License Number | 849118
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------