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General NPI Number Information
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NPI Number | 1871292128
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Entity Type | Individual
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Provider Name | KUSHALDEEP FNU
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Gender | Female
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Dates
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Enumeration Date | 02/27/2023
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Last Update Date | 03/14/2024
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Provider Practice Location Address
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Address Line | 3223 N BROAD ST
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City | PHILADELPHIA
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State | PA
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Zip | 19140-5007
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Country | US
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Telephone | 215-707-7747
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Fax |
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Provider Business Mailing Address
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Address Line | 3223 N BROAD ST, ROOM 2A05 (SECOND FLOOR)
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City | PHILADELPHIA
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State | PA
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Zip | 19140-1675
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Country | US
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Telephone | 215-707-7747
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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 | 1223P0700X
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Taxonomy Name | Prosthodontics
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License Number | DF11831
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License Number State | MA
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Taxonomy #2
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Taxonomy Code | 1223P0700X
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Taxonomy Name | Prosthodontics
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License Number | RFD000068
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License Number State | PA
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