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General NPI Number Information
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NPI Number | 1255083721
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Entity Type | Individual
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Provider Name | JAPNEET RANDHAWA
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Gender | Female
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Dates
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Enumeration Date | 01/25/2022
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Last Update Date | 01/25/2022
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Provider Practice Location Address
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Address Line | 3870 BROAD ST STE 1
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City | SAN LUIS OBISPO
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State | CA
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Zip | 93401-7172
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Country | US
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Telephone | 805-214-4071
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Fax |
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Provider Business Mailing Address
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Address Line | 384 UNION AVE APT C
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City | CAMPBELL
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State | CA
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Zip | 95008-4287
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Country | US
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Telephone | 224-421-8863
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | 107267
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License Number State | CA
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