=====================================================
General NPI Number Information
=====================================================
NPI Number | 1225262264
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SIMRAN SEKHON M.B.B.S
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/05/2009
-----------------------------------------------------
Last Update Date | 08/24/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9143 CEDAR RIDGE DR
-----------------------------------------------------
City | GRANITE BAY
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95746-7234
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 352-870-8135
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 140 HEMSTEAD ST
-----------------------------------------------------
City | LAKE BLUFF
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60044-1155
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 847-735-1524
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2085R0202X
-----------------------------------------------------
Taxonomy Name | Diagnostic Radiology Physician
-----------------------------------------------------
License Number | A106324
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------