=====================================================
General NPI Number Information
=====================================================
NPI Number | 1851312789
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | NAVJEET KAUR GANDHOK M.D.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/23/2006
-----------------------------------------------------
Last Update Date | 07/26/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 13660 N 94TH DR SUITE C4
-----------------------------------------------------
City | PEORIA
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85381-4836
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 623-933-7453
-----------------------------------------------------
Fax | 623-974-3870
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3951 E NAVIGATOR LN
-----------------------------------------------------
City | PHOENIX
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85050-5449
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 480-515-6251
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number | 34288
-----------------------------------------------------
License Number State | AZ
-----------------------------------------------------