Provider Demographics
NPI:1982881991
Name:KAUR, SHIVINDER B (MD)
Entity Type:Individual
Prefix:DR
First Name:SHIVINDER
Middle Name:B
Last Name:KAUR
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 1:512 WESTLINE DR
Mailing Address - Street 2:SUITE 103
Mailing Address - City:ALAMEDA
Mailing Address - State:CA
Mailing Address - Zip Code:94501-7649
Mailing Address - Country:US
Mailing Address - Phone:510-522-4252
Mailing Address - Fax:510-522-6245
Practice Address - Street 1:512 WESTLINE DR
Practice Address - Street 2:SUITE 103
Practice Address - City:ALAMEDA
Practice Address - State:CA
Practice Address - Zip Code:94501-7649
Practice Address - Country:US
Practice Address - Phone:510-522-4252
Practice Address - Fax:510-522-6245
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-22
Last Update Date:2008-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA49175174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A491750Medicaid
CAF08694Medicare UPIN
CA00A491750Medicaid