Individual provider Active NPI

Pardeep Kaur

  • Family Nurse Practitioner
  • Fremont, CA
National Provider Identifier
1083332076
Registry record updated Aug 28, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
95021494 Issued in CA
Practice address
39500 Liberty St
Fremont, CA 94538-2211
Phone
(510) 770-8040
NPI assigned
Aug 16, 2022
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 28, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 95021494 CA Primary

Addresses

Primary practice location

39500 Liberty St
Fremont, CA 94538-2211

Mailing address

39500 Liberty St
Fremont, CA 94538-2211
Phone (510) 770-8040

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20230911004357 CA Practitioner - Nurse Practitioner 9537523444 Reassigns benefits to 3 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Geri Connection CurrentSince Jul 15, 2023 Accepting new patients
California Care Wellness Medical Center Inc. CurrentSince Jul 15, 2023 Accepting new patients
Myndfull Care California PC CurrentSince Feb 17, 2024 Accepting new patients
Myndfull Care Management California PC CurrentSince Jul 15, 2023 Accepting new patients

Locations

15644 Pomerado Rd
Ste 202
Poway, CA 92064
Phone (619) 320-8090

8445 Camino Santa Fe
Ste 215
San Diego, CA 92121
Phone (619) 541-3246

6280 Jackson Dr
Ste 8
San Diego, CA 92119
Phone (619) 464-1607

9436 W Lake Mead Blvd
Ste 5
Las Vegas, NV 89134
Phone (702) 328-7648

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1660608000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1661644800000",
    "number": "1083332076",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "39500 LIBERTY ST",
            "city": "FREMONT",
            "state": "CA",
            "postal_code": "945382211",
            "telephone_number": "510-770-8040"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "39500 LIBERTY ST",
            "city": "FREMONT",
            "state": "CA",
            "postal_code": "945382211",
            "telephone_number": "510-770-8040"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KAUR",
        "first_name": "PARDEEP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-08-16",
        "last_updated": "2022-08-28",
        "certification_date": "2022-08-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "CA",
            "license": "95021494",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fremont, CA

Sources for this page

Verify at the official NPI Registry.