Provider Demographics
NPI:1245793215
Name:SEKHON, PRABDEEP
Entity Type:Individual
Prefix:
First Name:PRABDEEP
Middle Name:
Last Name:SEKHON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:151 E AVENUE J STE A
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:CA
Mailing Address - Zip Code:93535-3516
Mailing Address - Country:US
Mailing Address - Phone:818-588-5362
Mailing Address - Fax:
Practice Address - Street 1:151 E AVENUE J STE A
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:CA
Practice Address - Zip Code:93535-3516
Practice Address - Country:US
Practice Address - Phone:661-942-1179
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-08
Last Update Date:2023-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA105183122300000X
AL390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program