Provider Demographics
NPI:1730068065
Name:KANDOLA, SANDEEP KAUR
Entity type:Individual
Prefix:
First Name:SANDEEP
Middle Name:KAUR
Last Name:KANDOLA
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 1:2961 TAYLOR RD
Mailing Address - Street 2:
Mailing Address - City:LOOMIS
Mailing Address - State:CA
Mailing Address - Zip Code:95650-9503
Mailing Address - Country:US
Mailing Address - Phone:530-613-8305
Mailing Address - Fax:
Practice Address - Street 1:7959 ORANGE AVE
Practice Address - Street 2:
Practice Address - City:FAIR OAKS
Practice Address - State:CA
Practice Address - Zip Code:95628-5916
Practice Address - Country:US
Practice Address - Phone:916-307-0478
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-30
Last Update Date:2025-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA728651164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse