Provider Demographics
NPI:1629840418
Name:KALLAH, AMANDEEP KAUR
Entity Type:Individual
Prefix:MRS
First Name:AMANDEEP
Middle Name:KAUR
Last Name:KALLAH
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:UPENN SCHOOL OF DENTAL MEDICINE
Mailing Address - Street 2:240 SOUTH 40TH STREET, OFFICE OF CLINICAL AFFAIRS-S6A E
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19104
Mailing Address - Country:US
Mailing Address - Phone:215-573-2588
Mailing Address - Fax:
Practice Address - Street 1:UPENN SCHOOL OF DENTAL MEDICINE
Practice Address - Street 2:240 SOUTH 40TH STREET, OFFICE OF CLINICAL AFFAIRS-S6A E
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19104
Practice Address - Country:US
Practice Address - Phone:215-573-2588
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-25
Last Update Date:2023-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Single Specialty