Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208D00000X | General Practice Physician | 1931 | NE |
NPI | 1033642962 |
---|---|
Provider Name | Kimpreet Kaur |
First Address | Jbsa Ft Sam Houston, TX 78234-4504 |
Second Address | Jbsa Lackland Afb, TX 78324-9907 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/04/2017 |
Last Update Date | 11/12/2018 |