Provider Demographics
NPI:1235670134
Name:SINGH, KULWINDER (PHD)
Entity Type:Individual
Prefix:
First Name:KULWINDER
Middle Name:
Last Name:SINGH
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5011 PASEO DALI
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92603-3321
Mailing Address - Country:US
Mailing Address - Phone:415-245-0394
Mailing Address - Fax:
Practice Address - Street 1:806 MANHATTAN BEACH BLVD STE 207
Practice Address - Street 2:
Practice Address - City:MANHATTAN BEACH
Practice Address - State:CA
Practice Address - Zip Code:90266-4961
Practice Address - Country:US
Practice Address - Phone:310-376-3388
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-13
Last Update Date:2017-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY28488103TB0200X, 103TC0700X, 103TH0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
No103TH0004XBehavioral Health & Social Service ProvidersPsychologistHealth
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA81-4265148OtherEMPLOYEE IDENTIFICATION NUMBER