Provider Demographics
NPI:1245876051
Name:KAUSHAL, KARUN (DDS)
Entity type:Individual
Prefix:
First Name:KARUN
Middle Name:
Last Name:KAUSHAL
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2432 MAINSAIL CT
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:94534-1784
Mailing Address - Country:US
Mailing Address - Phone:707-389-0702
Mailing Address - Fax:
Practice Address - Street 1:2432 MAINSAIL CT
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:CA
Practice Address - Zip Code:94534-1784
Practice Address - Country:US
Practice Address - Phone:707-389-0702
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-27
Last Update Date:2019-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1045581223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice