Provider Demographics
NPI:1285270611
Name:KAUR, JASDEEP
Entity type:Individual
Prefix:
First Name:JASDEEP
Middle Name:
Last Name:KAUR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:58375 29 PALMS HWY
Mailing Address - Street 2:
Mailing Address - City:YUCCA VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92284-5813
Mailing Address - Country:US
Mailing Address - Phone:760-820-9229
Mailing Address - Fax:760-820-9228
Practice Address - Street 1:6530 LA CONTENTA RD STE 100
Practice Address - Street 2:
Practice Address - City:YUCCA VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92284-7313
Practice Address - Country:US
Practice Address - Phone:760-820-9229
Practice Address - Fax:760-820-9228
Is Sole Proprietor?:No
Enumeration Date:2019-11-20
Last Update Date:2019-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95013105363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care