Provider Demographics
NPI:1225018237
Name:DOSANJH, KULJINDER (PA)
Entity Type:Individual
Prefix:
First Name:KULJINDER
Middle Name:
Last Name:DOSANJH
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:KULJINDER
Other - Middle Name:
Other - Last Name:SAHOTA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:17750 SAN CANDELO ST
Mailing Address - Street 2:
Mailing Address - City:FOUNTAIN VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92708-5336
Mailing Address - Country:US
Mailing Address - Phone:209-602-8429
Mailing Address - Fax:
Practice Address - Street 1:3033 W ORANGE AVE
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92804-3156
Practice Address - Country:US
Practice Address - Phone:714-229-4088
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-18
Last Update Date:2021-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA16170364SE0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SE0003XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistEmergency
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0PA161700Medicaid
CAPA16170Medicaid
CA0PA161700OtherBLUE SHIELD
CA0PA161700OtherBLUE SHIELD
P76620Medicare UPIN