MEDICARE: ISHWPRIYA KAMAL SINGH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	390200000X	Student in an Organized Health Care Education/Training Program
2	122300000X	Dentist	D14588	MN

General Provider Information

NPI Number	:	1699358648
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ISHWPRIYA KAMAL SINGH

Provider Business Mailing Address
First Line	:	6037 ZENITH AVE S
Second Line	:
City	:	EDINA
State	:	MN
Zip	:	55410-2837
Country	:	US
Telephone Number	:	952-288-6760
Fax Number	:

Provider Business Practice Location Address
First Line	:	606 24TH AVE S STE 200
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55454-1437
Country	:	US
Telephone Number	:	612-659-8683
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/28/2021
Last Update Date	:	08/31/2022

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