Provider Demographics
NPI:1568750461
Name:KAUR, DOMINDER (MB,BS, MSC)
Entity Type:Individual
Prefix:DR
First Name:DOMINDER
Middle Name:
Last Name:KAUR
Suffix:
Gender:F
Credentials:MB,BS, MSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3959 BROADWAY # CHN10
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10032-1559
Mailing Address - Country:US
Mailing Address - Phone:212-305-9770
Mailing Address - Fax:507-609-3180
Practice Address - Street 1:161 FT WASHINGTN AVE # IP-7
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10032-3729
Practice Address - Country:US
Practice Address - Phone:212-305-8165
Practice Address - Fax:212-305-5848
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-13
Last Update Date:2020-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2959022080P0207X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0207XAllopathic & Osteopathic PhysiciansPediatricsPediatric Hematology-Oncology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program