Provider Demographics
NPI:1447609680
Name:BRAR, KULWINDER
Entity Type:Individual
Prefix:
First Name:KULWINDER
Middle Name:
Last Name:BRAR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KULWINDER
Other - Middle Name:
Other - Last Name:BRAICH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:12050 VENTURA BLVD STE C101
Mailing Address - Street 2:
Mailing Address - City:STUDIO CITY
Mailing Address - State:CA
Mailing Address - Zip Code:91604-2639
Mailing Address - Country:US
Mailing Address - Phone:818-296-9142
Mailing Address - Fax:
Practice Address - Street 1:12050 VENTURA BLVD STE C101
Practice Address - Street 2:
Practice Address - City:STUDIO CITY
Practice Address - State:CA
Practice Address - Zip Code:91604-2639
Practice Address - Country:US
Practice Address - Phone:818-296-9142
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-08
Last Update Date:2019-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADDS1039151223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty