Basic Information
Provider Information
NPI: 1033511266
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: KAUR
FirstName: GURCHARANJIT
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1200 B GALE WILSON BLVD
Address2:  
City: FAIRFIELD
State: CA
PostalCode: 945333552
CountryCode: US
TelephoneNumber: 7076465611
FaxNumber: 7076464902
Practice Location
Address1: 1649 ROMA DR
Address2:  
City: PITTSBURG
State: CA
PostalCode: 945657989
CountryCode: US
TelephoneNumber: 7076284293
FaxNumber:  
Other Information
ProviderEnumerationDate: 09/18/2014
LastUpdateDate: 08/30/2017
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363LF0000XNP95001201CAY Physician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily

No ID Information.


Home