Provider Demographics
NPI:1033917943
Name:SANGHA, KIRANDEEP KAUR
Entity type:Individual
Prefix:
First Name:KIRANDEEP
Middle Name:KAUR
Last Name:SANGHA
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1204 W SHAW AVE # 102
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93711-3706
Mailing Address - Country:US
Mailing Address - Phone:559-681-1947
Mailing Address - Fax:
Practice Address - Street 1:1204 W SHAW AVE # 102
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93711-3706
Practice Address - Country:US
Practice Address - Phone:559-681-1947
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-05
Last Update Date:2025-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X
CA20916101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)