Provider Demographics
NPI:1326292400
Name:HUNDAL, PRADEEP KAUR (MD)
Entity Type:Individual
Prefix:
First Name:PRADEEP
Middle Name:KAUR
Last Name:HUNDAL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1725 OCEAN FRONT WALK APT 809
Mailing Address - Street 2:
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90401-3138
Mailing Address - Country:US
Mailing Address - Phone:310-913-1974
Mailing Address - Fax:
Practice Address - Street 1:593 EDDY ST
Practice Address - Street 2:APC 7
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02903-4923
Practice Address - Country:US
Practice Address - Phone:401-444-3565
Practice Address - Fax:401-444-5493
Is Sole Proprietor?:No
Enumeration Date:2008-11-16
Last Update Date:2017-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA121063207R00000X
RIMD13682207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine