Provider Demographics
NPI:1245513167
Name:BASUTA, KIRIN KAUR
Entity type:Individual
Prefix:MS
First Name:KIRIN
Middle Name:KAUR
Last Name:BASUTA
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 1:25975 NORMANDIE AVE DEPT OF
Mailing Address - Street 2:
Mailing Address - City:HARBOR CITY
Mailing Address - State:CA
Mailing Address - Zip Code:90710-3416
Mailing Address - Country:US
Mailing Address - Phone:424-251-7794
Mailing Address - Fax:
Practice Address - Street 1:SOCIAL MEDICINE
Practice Address - Street 2:25975 S. NORMANDIE AVE
Practice Address - City:HARBOR CITY
Practice Address - State:CA
Practice Address - Zip Code:90710
Practice Address - Country:US
Practice Address - Phone:424-251-7794
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-27
Last Update Date:2022-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCSW803851041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical