Individual
SANDEEP KAUR
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
9404A MAIN ST, FAIRFAX, VA 22031-4032
(571) 404-6974
Mailing address
9404-A MAIN STREET, FAIRFAX, VA 22031
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
0110009500
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0110009500
—
VA
05
—
30017688630001
—
VA
Enumeration date
08/28/2023
Last updated
11/05/2024
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