Provider Demographics
NPI:1174372577
Name:GILL, GAGANDEEP KAUR (NP)
Entity type:Individual
Prefix:
First Name:GAGANDEEP
Middle Name:KAUR
Last Name:GILL
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:23673 PARK CAPRI UNIT 42
Mailing Address - Street 2:
Mailing Address - City:CALABASAS
Mailing Address - State:CA
Mailing Address - Zip Code:91302-1629
Mailing Address - Country:US
Mailing Address - Phone:661-717-0951
Mailing Address - Fax:
Practice Address - Street 1:415 ROLLING OAKS DR
Practice Address - Street 2:
Practice Address - City:THOUSAND OAKS
Practice Address - State:CA
Practice Address - Zip Code:91361-1029
Practice Address - Country:US
Practice Address - Phone:818-336-1295
Practice Address - Fax:818-337-1285
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-16
Last Update Date:2024-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP950287092086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery