Provider Demographics
NPI:1194302794
Name:KHURANA, SUKHDEEP SINGH
Entity type:Individual
Prefix:
First Name:SUKHDEEP
Middle Name:SINGH
Last Name:KHURANA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:SUKHDEEP
Other - Middle Name:
Other - Last Name:SINGH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 5540
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85261-5540
Mailing Address - Country:US
Mailing Address - Phone:480-805-8855
Mailing Address - Fax:
Practice Address - Street 1:5620 W THUNDERBIRD RD STE E5
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85306-4651
Practice Address - Country:US
Practice Address - Phone:480-805-8855
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-28
Last Update Date:2024-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
AZ72545207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program