Provider Demographics
NPI:1689031130
Name:PINKY, KIRANDEEP KAUR
Entity Type:Individual
Prefix:
First Name:KIRANDEEP
Middle Name:KAUR
Last Name:PINKY
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 1:15906 W E ST
Mailing Address - Street 2:
Mailing Address - City:KERMAN
Mailing Address - State:CA
Mailing Address - Zip Code:93630-1246
Mailing Address - Country:US
Mailing Address - Phone:559-567-9531
Mailing Address - Fax:
Practice Address - Street 1:3645 NORTHGATE BLVD
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95834-1641
Practice Address - Country:US
Practice Address - Phone:916-576-1403
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-01-27
Last Update Date:2016-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA100010122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist