Provider Demographics
NPI:1811155476
Name:CHAHAL, PUNEET KAUR (MD)
Entity type:Individual
Prefix:DR
First Name:PUNEET
Middle Name:KAUR
Last Name:CHAHAL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2321 E 4TH ST STE C637
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92705-3861
Mailing Address - Country:US
Mailing Address - Phone:714-664-0045
Mailing Address - Fax:714-664-0049
Practice Address - Street 1:720 N TUSTIN AVE
Practice Address - Street 2:201
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92705-3606
Practice Address - Country:US
Practice Address - Phone:714-664-0045
Practice Address - Fax:714-664-0049
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-29
Last Update Date:2021-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA88986207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACJ873AMedicare UPIN