Provider Demographics
NPI:1376284265
Name:KAUR, SUKHVINDER
Entity Type:Individual
Prefix:
First Name:SUKHVINDER
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 1:1769 SHELLSTONE WAY
Mailing Address - Street 2:
Mailing Address - City:RIPON
Mailing Address - State:CA
Mailing Address - Zip Code:95366-9654
Mailing Address - Country:US
Mailing Address - Phone:209-814-6634
Mailing Address - Fax:
Practice Address - Street 1:5330 PIRRONE RD STE 303
Practice Address - Street 2:
Practice Address - City:SALIDA
Practice Address - State:CA
Practice Address - Zip Code:95368-8205
Practice Address - Country:US
Practice Address - Phone:209-846-9488
Practice Address - Fax:209-247-4555
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-05
Last Update Date:2022-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP95018288251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based