Basic Information
Provider Information | |||||||||
NPI: | 1346235686 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | KAUR | ||||||||
FirstName: | PARVEEN | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | MD | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | KASTURI | ||||||||
OtherFirstName: | PARVEEN | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: | M.D. | ||||||||
OtherLastNameType: | 2 | ||||||||
Mailing Information | |||||||||
Address1: | 1845 N FAIR OAKS AVE STE G-151 | ||||||||
Address2: |   | ||||||||
City: | PASADENA | ||||||||
State: | CA | ||||||||
PostalCode: | 911031620 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 5628677999 | ||||||||
FaxNumber: |   | ||||||||
Practice Location | |||||||||
Address1: | 3131 SANTA ANITA AVE | ||||||||
Address2: | #109 | ||||||||
City: | EL MONTE | ||||||||
State: | CA | ||||||||
PostalCode: | 917331369 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 6264449453 | ||||||||
FaxNumber: | 6264449256 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 09/13/2005 | ||||||||
LastUpdateDate: | 06/22/2020 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 06/22/2020 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RI0200X | A56110 | CA | N |   | Allopathic & Osteopathic Physicians | Internal Medicine | Infectious Disease | 207R00000X | A56110 | CA | Y |   | Allopathic & Osteopathic Physicians | Internal Medicine |   |
No ID Information.