Provider Demographics
NPI:1497251672
Name:PUREWAL, JASKEERIT KAUR (MD)
Entity Type:Individual
Prefix:
First Name:JASKEERIT
Middle Name:KAUR
Last Name:PUREWAL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KEERIT
Other - Middle Name:
Other - Last Name:PUREWAL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:5767 W CENTURY BLVD STE 400
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90045-5631
Mailing Address - Country:US
Mailing Address - Phone:310-301-8771
Mailing Address - Fax:
Practice Address - Street 1:141 TRIUNFO CANYON RD STE 110
Practice Address - Street 2:
Practice Address - City:WESTLAKE VILLAGE
Practice Address - State:CA
Practice Address - Zip Code:91361-2525
Practice Address - Country:US
Practice Address - Phone:805-371-1393
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-05
Last Update Date:2021-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CAA174354207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program