Provider Demographics
NPI:1790366920
Name:VIRK, PAWANDEEP KAUR (MD)
Entity type:Individual
Prefix:
First Name:PAWANDEEP
Middle Name:KAUR
Last Name:VIRK
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:603 W SOMBRA WAY
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN HOUSE
Mailing Address - State:CA
Mailing Address - Zip Code:95391-2097
Mailing Address - Country:US
Mailing Address - Phone:510-910-3808
Mailing Address - Fax:
Practice Address - Street 1:1470 BESSIE AVE
Practice Address - Street 2:
Practice Address - City:TRACY
Practice Address - State:CA
Practice Address - Zip Code:95376-3417
Practice Address - Country:US
Practice Address - Phone:209-833-0525
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-19
Last Update Date:2025-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA191985207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine