Provider Demographics
NPI:1013072578
Name:SANDHU, KIRAN (DDS)
Entity Type:Individual
Prefix:
First Name:KIRAN
Middle Name:
Last Name:SANDHU
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:505 W MORTON AVE
Mailing Address - Street 2:
Mailing Address - City:PORTERVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:93257-3303
Mailing Address - Country:US
Mailing Address - Phone:559-782-8930
Mailing Address - Fax:
Practice Address - Street 1:505 W MORTON AVE
Practice Address - Street 2:
Practice Address - City:PORTERVILLE
Practice Address - State:CA
Practice Address - Zip Code:93257-3303
Practice Address - Country:US
Practice Address - Phone:559-782-8930
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-26
Last Update Date:2013-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA529261223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice