Provider Demographics
NPI:1043809478
Name:KAUR, KAMALDEEP
Entity Type:Individual
Prefix:
First Name:KAMALDEEP
Middle Name:
Last Name:KAUR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4120 N. 108TH AVE
Mailing Address - Street 2:STE 116
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85037
Mailing Address - Country:US
Mailing Address - Phone:632-872-1818
Mailing Address - Fax:623-872-1819
Practice Address - Street 1:4120 N. 108TH AVE
Practice Address - Street 2:STE 116
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85037
Practice Address - Country:US
Practice Address - Phone:632-872-1818
Practice Address - Fax:623-872-1819
Is Sole Proprietor?:No
Enumeration Date:2021-01-11
Last Update Date:2023-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ248601207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine