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General NPI Number Information
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NPI Number | 1184814758
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Entity Type | Individual
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Provider Name | KIRANJOT KAUR RANDHAWA D.O
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Gender | Female
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Dates
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Enumeration Date | 07/30/2007
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Last Update Date | 12/16/2010
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Provider Practice Location Address
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Address Line | 455 E COLUMBIA ST SUITE 201 & 6
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City | LONG BEACH
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State | CA
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Zip | 90806-1620
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Country | US
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Telephone | 562-933-0400
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Fax |
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Provider Business Mailing Address
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Address Line | 2135 CRESCENT DR
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City | SIGNAL HILL
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State | CA
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Zip | 90755-5622
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Country | US
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Telephone | 562-933-0494
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 2OA9915
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License Number State | CA
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